Outcome of High Dose Vasopressor Therapy in Septic Shock

2019 ◽  
Author(s):  
C. Meenach ◽  
A. Kelly ◽  
E. Bensadoun
Keyword(s):  
Septic Shock ◽  
High Dose ◽  
Vasopressor Therapy

scholarly journals High-Dose Vasopressor Therapy for Pediatric Septic Shock: When Is Too Much?

2020 ◽  
Vol 09 (03) ◽  
pp. 172-180
Author(s):  
Paulo Sérgio Lucas da Silva ◽  
Marcelo Cunio Machado Fonseca
Keyword(s):  
Septic Shock ◽  
Hazard Ratio ◽  
High Dose ◽  
Vasopressor Therapy ◽  
Single Center ◽  
Prognostic Predictor ◽  
Observational Analysis ◽  
Poor Outcome

AbstractIt is unknown if the requirement for high dose of vasopressor (HDV) represents a poor outcome in pediatric septic shock. This is a retrospective observational analysis with data obtained from a single center. We evaluated the association between the use of HDV and survival in these patients. A total of 62 children (38 survivors and 24 nonsurvivors) were assessed. The dose of vasopressor (hazard ratio 2.06) and oliguria (hazard ratio 3.17) was independently associated with mortality. The peak of vasopressor was the best prognostic predictor. A cutoff of 1.3 μg/kg/min was associated with mortality with a sensitivity of 75% and specificity of 89%. Vasopressor administration higher than 1.3 μg/kg/min was associated with increased mortality in children with septic shock.

scholarly journals Outcome of patients with septic shock and high-dose vasopressor therapy

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Thomas Auchet ◽  
Marie-Alix Regnier ◽  
Nicolas Girerd ◽  
Bruno Levy
Keyword(s):  
Septic Shock ◽  
High Dose ◽  
Vasopressor Therapy

scholarly journals Ischemic limb necrosis in septic shock: What is the role of high‐dose vasopressor therapy?

2019 ◽  
Vol 17 (11) ◽  
pp. 1973-1978 ◽  
Author(s):  
Jerrold H. Levy ◽  
Kamrouz Ghadimi ◽  
David Faraoni ◽  
Sean Diepen ◽  
Bruno Levy ◽  
...  
Keyword(s):  
Septic Shock ◽  
High Dose ◽  
Vasopressor Therapy ◽  
Ischemic Limb

Effect of Vasopressin Dose on Hemodynamic Response in Obese Patients With Septic Shock: A Retrospective Observational Study

2021 ◽  
pp. 106002802110072
Author(s):  
Casey A. Dubrawka ◽  
Kevin D. Betthauser ◽  
Hannah E. Pope ◽  
Gabrielle A. Gibson
Keyword(s):  
Septic Shock ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Standard Dose ◽  
Hemodynamic Response ◽  
Percentage Change ◽  
High Dose ◽  
Obese Patients ◽  
Improved Outcomes ◽  
Higher Doses

Background No clear association between standard vasopressin doses and body mass index exists, despite potential pharmacokinetic and pharmacodynamic variability among patients with septic shock. It is unknown if higher doses may alter hemodynamic response. Objective The purpose of this study was to evaluate the effect of vasopressin dose on hemodynamic response in obese patients with septic shock. Methods A single-center, retrospective cohort study was conducted in adult, obese patients with septic shock receiving catecholamine vasopressors and vasopressin. Patients were analyzed according to vasopressin dose received: standard dose (≤0.04 U/min) and high dose (>0.04 U/min). The primary outcome was percentage change in norepinephrine equivalent (NEQ) dose. Results A total of 182 patients were included in the analysis, with 136 in the standard-dose vasopressin group and 46 in the high-dose vasopressin group. There was no difference in percentage change in NEQ dose at 6 hours after standard- or high-dose vasopressin attainment (−28.6% vs −19.1%; P = 0.166). A greater increase in mean arterial pressure (MAP) at 6 hours was observed with receipt of high-dose vasopressin (23.3% vs 15.3%; P = 0.023). Duration of shock and length of stay were significantly longer in patients who received high-dose vasopressin, with no difference in in-hospital mortality. Conclusion and Relevance This represents the first analysis comparing standard and higher doses of vasopressin in obese patients with septic shock. Receipt of high-dose vasopressin was not associated with a difference in catecholamine requirement or improved outcomes. Further studies are warranted to provide guidance on the use of high-dose vasopressin in septic shock.

scholarly journals Pierson Syndrome Associated with Hypothyroidism and Septic Shock

2020 ◽  
Vol 20 (4) ◽  
pp. e385-389
Author(s):  
Areeba Ejaz ◽  
Meher B. Ali ◽  
Fatima Siddiqui ◽  
Mashal B. Ali ◽  
Ammarah Jamal
Keyword(s):  
Septic Shock ◽  
Nephrotic Syndrome ◽  
Neuromuscular Junctions ◽  
Normal Component ◽  
Congenital Nephrotic Syndrome ◽  
Psychomotor Retardation ◽  
Basement Membranes ◽  
High Dose ◽  
Converting Enzyme Inhibitors ◽  
Pierson Syndrome

Pierson syndrome is caused by mutations in the laminin β2 gene causing absent β2 laminin, which is a normal component of the basement membranes of the mature glomerulus, structures in the anterior eye and neuromuscular junctions. The mutations manifest as congenital nephrotic syndrome and microcoria which are characteristic ocular features of this disease. These mutations may also result in neurological abnormalities such as hypotonia and psychomotor retardation. We report a two-month old boy who presented to the Pediatrics Department of Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan, in 2015, with the typical features of microcoria and congenital nephrotic syndrome. The hypocalcaemia, hypoproteinaemia and probable immunocompromised state consequent to nephrotic syndrome resulted in seizures, hypothyroidism and urosepsis. Despite being treated aggressively with high dose antibiotics, ionotropic support, angiotensin-converting enzyme inhibitors, thyroxine replacement and nutritional support, the infant died due to significant multiorgan disease including renal failure and septic shock. Keywords: Pierson Syndrome; Microcoria and Congenital Nephrotic Syndrome; Congenital Microcoria; Hypothyroidism; Septic Shock; Case Report; Pakistan.

Hydrocortisone Therapy for Patients with Septic Shock

2018 ◽  
pp. 301-306
Author(s):  
Ryan J. Horvath ◽  
Edward Bittner
Keyword(s):  
Septic Shock ◽  
Study Design ◽  
Steroid Therapy ◽  
Clinical Case ◽  
Low Dose ◽  
Vasopressor Therapy ◽  
Surviving Sepsis Campaign ◽  
Number Of Patients ◽  
Study Intervention

This chapter provides a summary of the landmark study known as the CORTICUS trial. Among patients suffering from septic shock, does low dose hydrocortisone improve mortality? Starting with that question, it describes the basics of the study, including funding, study location, the population studies, number of patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The CORTICUS trial failed to demonstrate a benefit on mortality with steroid therapy among patients with septic shock. Based on CORTICUS and other studies, the Surviving Sepsis Campaign guidelines no longer recommend steroids for all patients with septic shock. Corticosteroids should be considered, however, for patients with septic shock who do not respond to fluids and vasopressor therapy.

scholarly journals Aldosterone secretion in patients with septic shock: a prospective study

2013 ◽  
Vol 57 (8) ◽  
pp. 636-641 ◽  
Author(s):  
Rafael Barberena Moraes ◽  
Gilberto Friedman ◽  
Marina Verçoza Viana ◽  
Tiago Tonietto ◽  
Henrique Saltz ◽  
...  
Keyword(s):  
Septic Shock ◽  
Serum Levels ◽  
Zona Glomerulosa ◽  
High Dose ◽  
Zona Fasciculata ◽  
Cortisol Secretion ◽  
Aldosterone Secretion ◽  
Acth Stimulation ◽  
Aldosterone Production ◽  
A Prospective Study

OBJECTIVE: To assess serum levels of the main factors that regulate the activation of the zona glomerulosa and aldosterone production in patients with septic shock, as well as their response to a high-dose (250 µg) adrenocorticotropic hormone (ACTH) stimulation test. SUBJECTS AND METHODS: In 27 patients with septic shock, baseline levels of aldosterone, cortisol, ACTH, renin, sodium, potassium, and lactate were measured, followed by a cortrosyn test. RESULTS: Renin correlated with baseline aldosterone and its variation after cortrosyn stimulation. Baseline cortisol and its variation did not correlate with ACTH. Only three patients had concomitant dysfunction of aldosterone and cortisol secretion. CONCLUSIONS: Activation of the zona glomerulosa and zona fasciculata are independent. Aldosterone secretion is dependent on the integrity of the renin-angiotensin-aldosterone system, whereas cortisol secretion does not appear to depend predominantly on the hypothalamic-pituitary-adrenal axis. These results suggest that activation of the adrenal gland in critically ill patients occurs by multiple mechanisms.

A Controlled Clinical Trial of High-Dose Methylprednisolone in the Treatment of Severe and Septic Shock

1988 ◽  
Vol 32 (2) ◽  
pp. 125???127
Author(s):  
R. C. BONE ◽  
C. J. FISHER ◽  
T. P. CLEMMER ◽  
G. J. SLOTMAN ◽  
C. A. METZ ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Septic Shock ◽  
Controlled Clinical Trial ◽  
High Dose ◽  
High Dose Methylprednisolone
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