Recent Updates in the Pharmacological Management of Sepsis and Septic Shock: A Systematic Review Focused on Fluid Resuscitation, Vasopressors, and Corticosteroids

2018 ◽  
Vol 53 (4) ◽  
pp. 385-395 ◽  
Author(s):  
John M. Allen ◽  
Carinda Feild ◽  
Bethany R. Shoulders ◽  
Stacy A. Voils
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Randomized Controlled Trials ◽  
Fluid Resuscitation ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Pharmacological Management ◽  
Randomized Controlled ◽  
Recent Developments ◽  
Sepsis And Septic Shock

Objective: Describe recent developments in the pharmacological management of sepsis and septic shock, focusing on fluid resuscitation, vasopressors, and corticosteroids. Data Sources: A literature search limited to randomized controlled trials written in the English language reporting mortality and other clinically relevant outcomes that were published from July 1, 2016, to August 31, 2018, in patients aged ≥ 18 years. Titles and abstracts were reviewed for relevance. References for pertinent review articles were also reviewed. Study Selection and Data Extraction: Relevant randomized controlled trials conducted in patients meeting the pre-defined inclusion criteria were considered for inclusion. Data Synthesis: From an initial search that identified 147 studies, 14 original research studies met inclusion criteria and were included in this review. Risk of bias (ROB) was assessed using the Revised Cochrane ROB assessment tool, with most included studies having a low ROB. Relevance to Patient Care and Clinical Practice: Sepsis and septic shock pose a significant burden on public health. Despite advances in our understanding of sepsis, mortality remains unacceptably high. Recent developments in the pharmacological management of septic shock have focused on determining optimal composition and dosage of fluid resuscitation, enhanced use of vasopressor therapy, and clarifying the role of corticosteroids. This systematic review will provide recommendations for application to practice focusing on recent research on these topics. Conclusions: Although recent developments in the pharmacological management of sepsis are encouraging, clinicians must be keen to utilize patient-specific factors to guide therapy and continue to strive to address the remaining unanswered questions.

The Efficacy and Safety Of Therapeutic Aheresis In Sepsis and Septic Shock: A Systematic Review and Meta-Analysis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1119-1119
Author(s):  
Emily K. Rimmer ◽  
Brett L. Houston ◽  
Anand Kumar ◽  
Ahmed Abou-Setta ◽  
Carol Friesen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Clinical Trials ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
The Mean ◽  
Sepsis And Septic Shock

Abstract Introduction Sepsis and septic shock are leading causes of ICU mortality. They are characterized by excessive host inflammation, upregulation of procoagulant proteins and depletion of natural anticoagulants. Therapeutic apheresis has the potential to improve survival in sepsis by removing injurious elements and inflammatory cytokines and restoring deficient plasma proteins. The objective of our systematic review was to evaluate the efficacy and safety of apheresis in patients with sepsis or septic shock. Methods We searched PubMed, EMBASE, and CENTRAL (from inception to February 2013), the International Clinical Trials Registry Platform, relevant conference proceedings and bibliographies of pertinent reviews and included clinical trials. Two reviewers independently identified randomized controlled trials of patients diagnosed with sepsis, severe sepsis, septic shock or disseminated intravascular coagulation due to infection who received plasmapheresis, plasma exchange, or plasma filtration compared to placebo or usual care. Two reviewers independently extracted trial-level data including population characteristics, interventions, outcomes, and funding sources. We assessed risk of bias using the Cochrane risk of bias tool. Our primary outcome was all-cause mortality reported at the longest follow-up. Secondary outcomes were hospital and ICU lengths of stay, and reported adverse events. We expressed summary effect measures as odds ratios (OR) with 95% confidence intervals (CI). Random effect models using the Mantel-Haenszel method were used for pooled analyses. Results We identified 1771 potential citations of which 3 trials (144 patients) met inclusion criteria. The mean age of patients ranged from 38 to 53 years in the two adult trials and 1 to 18 years in the single pediatric trial. The mean APACHE score was 25.2 (APACHE II) in one study and 54.9 (APACHE III) in the other study reporting illness severity scores. All 3 studies were adjudicated to be unclear or high risk of bias. We observed that the use of apheresis was not associated with a significant reduction in all cause mortality (OR 0.42, 95% CI 0.16 - 1.12, I2=30%) (see Figure). In a subgroup analysis of studies including children exclusively, we observed that apheresis was associated with a significant reduction in mortality (OR 0.03, 95% CI 0.00 – 0.94). None of the included studies reported ICU or hospital length of stay. Only one study reported adverse events associated with apheresis including 6 episodes of hypotension and one allergic reaction to fresh frozen plasma. Central-venous catheter related complications were not reported. Conclusions In patients with sepsis or septic shock, apheresis is not associated a significant reduction in all cause mortality. There is currently insufficient evidence to recommend apheresis as an adjunctive therapy in patients with sepsis or septic shock. Rigorous randomized controlled trials powered to detect differences in patient-centered, clinically relevant outcomes are required to evaluate the impact of apheresis in this patient population. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The effects of Rhodiola Rosea supplementation on depression, anxiety and mood – A Systematic Review

2020 ◽  
Vol 3 (1) ◽  
pp. 72-82
Author(s):  
Fanaras Konstantinos ◽  
Reinhard Heun
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Rhodiola Rosea ◽  
Depression Symptoms ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Moderate Depression ◽  
Literature Searches ◽  
Made In

AbstractObjectivesRhodiola rosea is an adaptogen herb from the Crassulaceae family, which has been vastly used in the Russian and Chinese medicine. The herb is used against depression, anxiety, mental and physical fatigue and to promote overall health. In this systematic review, we examined the effects of R. rosea on depression, anxiety and mood, as these are the most relevant to mental health.MethodsLiterature searches were made in PubMed using the term ‘Rhodiola rosea’. Inclusion criteria were: Randomized controlled trials using interventions of R. rosea on any type of participants, while focusing on the effects of the intervention on depression, anxiety or mood. Mixed interventions of R. rosea with other herbs were excluded. Studies not published in English or Greek were excluded.ResultsA total of 39 randomized controlled trials were identified and their abstract was screened. After screening, a total of 17 papers were excluded because they were focusing on irrelevant outcomes. The full text of the remaining 22 papers was read and an additional 17 papers were excluded. These papers were excluded because they were eventually not focusing on our main outcome or they were using R. rosea interventions with other herbs. In the end, a total of 5 papers (n = 327 participants) were found eligible for our systematic review. In these studies, R. rosea seems to improve the symptoms of mild to moderate depression, symptoms of mild anxiety and to enhance mood. The last date of our search was October 13, 2019.ConclusionRhodiola rosea supplementation may alleviate symptoms of mild to moderate depression and mild anxiety, while it may also enhance mood. The findings of our review are not definite due to the lack of available experimental data. Randomized controlled trials with a low risk of bias are needed to further study the herb.

Colloid Solutions for Fluid Resuscitation in Patients with Sepsis: Systematic Review of Randomized Controlled Trials

2013 ◽  
Vol 45 (4) ◽  
pp. 485-495 ◽  
Author(s):  
Jing-Zi Zhong ◽  
Dan Wei ◽  
Hong-Fei Pan ◽  
Yu-Jun Chen ◽  
Xiu-An Liang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Fluid Resuscitation ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals POS0800 VISUAL ISCHEMIA DURING RELAPSE AND FOLLOW-UP OF GIANT CELL ARTERITIS: A SYSTEMATIC REVIEW

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 652.2-652
Author(s):  
K. Bugdayli ◽  
P. Ungprasert ◽  
K. J. Warrington ◽  
M. Koster
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Retrospective Studies ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Rate Frequency

Background:Visual ischemia (VI) is one of the most feared complications in giant cell arteritis (GCA). While the frequencies of VI development at or near diagnosis are better studied, limited information is available regarding the frequency of VI during relapse.Objectives:The purpose of this study was to characterize the frequency of visual ischemia (VI) as a manifestation of relapse or during follow-up in patients with GCA through performance of a systematic literature review.Methods:Potentially eligible studies were identified from Medline and EMBASE databases from inception to November 31, 2019 using a search strategy that comprised of terms for “giant cell arteritis,” “temporal arteritis,” or “Horton’s disease,” with “relapse,” “recurrence,” “flare,” “outcome,” “follow-up,” or “prognosis.” VI was defined as transient or permanent, full or partial, monocular or binocular visual field loss. VI occurring within 4 wks of GCA diagnosis was considered due to active disease and not included as a relapse event. Inclusion criteria used: (1) original research reported in English, (2) GCA definition provided, (3) VI outcome described as one of the following: (a) relapse rate/frequency denoting the presence or absence of VI, or (b) absolute number of VI events (> 4 weeks after GCA diagnosis) even if total cohort relapse rate/frequency was not provided. In order to reduce bias from under-reporting of negative results, studies that reported relapse rates/frequencies with accompanying relapse characteristics but did not provide initial detail regarding the presence/absence of VI were also identified. In such circumstances, the primary authors were directly contacted for patient-level data regarding VI and these studies were included in the final analysis if such data were available and provided.Results:A total of 913 unique articles were identified and underwent screening. Among these, 148 articles underwent independent full-text review by two physicians (K.B. and M.J.K). 33 articles met full inclusion criteria and an additional 21 articles included data on relapse but did not report VI patient data in the publication. Responses were received from authors of 11 of these 21 studies allowing for inclusion. 44 studies accounting for 3,649 patients with GCA were identified. Average percentage of baseline VI was 19% (range 0-66%). The average length of follow-up was 3.4 years (range 0.4 to 8.7). VI developing > 4 weeks after GCA diagnosis was recorded in a total of 53 patients (1.5%).Study-defined relapses were reported in 36 studies. A total of 1,215 patients with at least one or more relapses were recorded among 2,592 patients under observation (47%). Among these 36 studies, VI occurred in 37 patients (3.0%) with at least one study defined relapse event.Comparing trial design, retrospective studies (n=25) reported 27 of 2,718 (1%) patients developed VI during follow-up whereas 19 of 541 (3.5%) patients in randomized controlled trials (n=8) developed VI during the trial or post-trial follow-up.Conclusion:This report outlines the first systematic review evaluating VI as a manifestation of relapse and during follow-up in GCA. Overall, VI > 4 weeks after GCA diagnosis is uncommon (1.5%) but is noted in up to 3% of patients with at least one relapse event. Frequencies of reported VI were 3.5 times higher in randomized controlled trials compared to retrospective studies.Disclosure of Interests:Kubra Bugdayli: None declared, Patompong Ungprasert: None declared, Kenneth J Warrington Grant/research support from: Financial support for research from Kiniksa, Eli Lilly, Matthew Koster: None declared

scholarly journals Benefits of esmolol in sepsis and septic shock in adults: a meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Chun Chen ◽  
Jing Zhang ◽  
Zemei Zhou
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Volume Index ◽  
Current Evidence ◽  
Controlled Trials ◽  
Central Venous ◽  
Randomized Controlled ◽  
Sepsis And Septic Shock

Abstract Background Sepsis affects millions of people each year, and brings substantial health and economic burden to the global. Esmolol may have the potential in the treatment of sepsis and septic shock in adults. However, current evidence remains controversial. Methods We systematically searched PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from their inception to September 19, 2020 for randomized controlled trials (RCTs) evaluating the efficacy of esmolol in sepsis and septic shock in adults. A random-effects meta-analysis was performed to combine effect estimates. Two investigators independently screened articles, extracted data, and assessed the quality of included studies. Results Seven RCTs were included with a total of 463 patients with sepsis and/or septic shock. Overall, compared with standard treatment, esmolol significantly decreased 28-day mortality (risk ratio [RR] 0.68, 95% confidence interval [CI] 0.52 to 0.88), and heart rate (standardized mean difference [SMD] -1.83, 95% CI -2.95 to -0.70) and troponin I (TnI) level (SMD − 0.59, 95% CI -1.02 to -0.16) at 24 hours after treatment; no significant effect was found on the length of intensive care unit stay, mean arterial pressure, central venous pressure, central venous oxygen saturation, Stroke Volume Index, tumor necrosis factor-a, interleukin 6, White Blood Cells and PO2/FiO2. Conclusions Esmolol treatment may be safe and effective in decreasing 28-day mortality, controlling heart rate, and preventing myocardial damage, but no evidence of effect on lung injury in sepsis and septic shock after fluid resuscitation early. There were no significant adverse effects on tissue perfusion and oxygen utilization.

scholarly journals Moxibustion for the Correction of Nonvertex Presentation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Qin-hong Zhang ◽  
Jin-huan Yue ◽  
Ming Liu ◽  
Zhong-ren Sun ◽  
Qi Sun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Cessation Of Treatment

Objectives. This study aims to assess the effectiveness and safety of moxibustion for the correction of nonvertex presentation.Methods. Records without language restrictions were searched up to February 2013 for randomized controlled trials (RCTs) comparing moxibustion with other therapies in women with a singleton nonvertex presentation. Cochrane risk of bias criteria were used to assess the methodological quality of the trials.Results. Seven of 392 potentially relevant studies met the inclusion criteria. When moxibustion was compared with other interventions, a meta-analysis revealed a significant difference in favor of moxibustion on the correction of nonvertex presentation at delivery (risk ratio (RR) 1.29, 95% confidence interval (CI) 1.12 to 1.49, andI2=0). The same findings applied to the cephalic presentation after cessation of treatment (RR 1.36, 95% CI 1.08 to 1.71, andI2=80%). A subgroup analysis that excluded two trials with a high risk of bias also indicated favorable effects (RR 1.63, 95% CI 1.42 to 1.86, andI2=0%). With respect to safety, moxibustion resulted in decreased use of oxytocin.Conclusion. Our systematic review and meta-analysis suggested that moxibustion may be an effective treatment for the correction of nonvertex presentation. Moreover, moxibustion might reduce the need for oxytocin.

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