Effect of hydrocortisone versus methylprednisolone on clinical outcomes in oncology patients with septic shock

2020 ◽  
pp. 107815522091078
Author(s):  
Emily McDonnell ◽  
Reagan Collins ◽  
Mike Hernandez ◽  
Anne Rain T. Brown
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Primary Outcome ◽  
Intensive Care Unit Mortality ◽  
Adjunctive Treatment ◽  
Oncology Patients ◽  
Lengths Of Stay ◽  
Shock Reversal ◽  
The Impact

Background Corticosteroids are used as adjunctive treatment of critical illness-related corticosteroid insufficiency in patients with septic shock. This study aims to compare the impact of hydrocortisone versus methylprednisolone on duration of septic shock in critically ill oncology patients. Methods Single-center, retrospective cohort study of adult patients receiving hydrocortisone ≥200 mg/day or methylprednisolone ≥40 mg/day with septic shock. The primary outcome was time to shock reversal defined as time to systolic blood pressure ≥90 mmHg without vasopressors for ≥24 h. Results Eighty-eight patients were included, 49 patients received hydrocortisone and 39 patients received methylprednisolone. Solid tumor malignancy was more common in the hydrocortisone group, while hematological malignancy was more common in the methylprednisolone group (p = 0.009). Time to shock reversal was similar between hydrocortisone and methylprednisolone groups (72.4 versus 70.4 h; p = 0.825). Intensive care unit mortality occurred in 51.02% versus 53.85% of patients in hydrocortisone versus methylprednisolone, respectively (p = 0.792). Patients who received methylprednisolone had higher rates of mechanical ventilation (89.74% versus 55.1%, p < 0.001) and longer intensive care unit and hospital lengths of stay (4.2 versus 11.4 days and 14.3 versus 25.7 days; p < 0.001) compared to hydrocortisone. No differences were seen in incidence of steroid-related adverse effects between groups. Conclusions In oncology patients with septic shock, the use of hydrocortisone versus methylprednisolone does not appear to affect time to shock reversal.

The morbidity and mortality of pediatric oncology patients presenting to the intensive care unit with septic shock

2008 ◽  
Vol 51 (5) ◽  
pp. 584-588 ◽  
Author(s):  
Catherine M. Pound ◽  
Donna L. Johnston ◽  
Rachel Armstrong ◽  
Isabelle Gaboury ◽  
Kusum Menon
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Pediatric Oncology ◽  
Morbidity And Mortality ◽  
Oncology Patients

The impact of multidisciplinary team care on decreasing intensive care unit mortality

2021 ◽  
Vol 5 (2) ◽  
pp. 13
Author(s):  
AmalA Al Khalfan ◽  
AhmedA Al Ghamdi ◽  
Stephanie De Simone ◽  
YasserH Hadi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidisciplinary Team ◽  
Intensive Care Unit Mortality ◽  
Team Care ◽  
The Impact

Nosocomial Infection After Septic Shock Among Intensive Care Unit Patients

2008 ◽  
Vol 29 (11) ◽  
pp. 1054-1065 ◽  
Author(s):  
Caroline Landelle ◽  
Alain Lepape ◽  
Adrien Français ◽  
Eve Tognet ◽  
Hélène Thizy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Initial Phase ◽  
Pulmonary Infection ◽  
University Hospital ◽  
Icu Patients ◽  
Significant Difference ◽  
The Impact

Objectives.To measure the incidence of nosocomial infection (NI) among patients with septic shock according to the place of septic shock acquisition and to evaluate the increase in the risk of pulmonary infection associated with septic shock.Design.Prospective cohort study.Setting.TWO intensive care units (ICUs) of a French university hospital.Patients and Methods.The study included a total of 209 septic shock patients during the period December 1, 2001 through April 30, 2005. The place of septic shock acquisition for 108 patients was the community; for 87, the hospital; and for 14, the ICU. To evaluate the impact of septic shock on the development of pulmonary infection, a competitive and adjusted hazard ratio (aHR) model was applied to nontrauma ICU patients.Results.Among the 209 study patients, 48 (23%) experienced 66 NIs after septic shock. There was no significant difference in the NI attack rates according to place of acquisition: for the community acquisition group, 24 cases per 100 patients (95% confidence interval [CI], 16-32); for the hospital acquisition group, 20 cases per 100 patients (95% CI, 11-28); and for the ICU acquisition group, 36 cases per 100 patients (95% CI, 11-61) (P = .3). For nontrauma ICU patients, the presence of community-acquired septic shock was found to be independently associated with a higher incidence of pulmonary infection, compared with the absence of septic shock (aHR, 2.12 [95% CI, 1.08-4.16]; P = .03).Conclusions.The risk of NI did not differ by the place of septic shock acquisition. The risk of pulmonary infection was higher for ICU patients with community-acquired septic shock who were admitted for underlying nontrauma disease. Studies are needed to investigate the pathogenic mechanisms that facilitate pulmonary infection in this population, taking into account exposure to invasive devices and immunosuppression after the initial phase of septic shock.

Compliance With a Sepsis Bundle and Its Effect on Intensive Care Unit Mortality in Surgical Septic Shock Patients

2010 ◽  
Vol 69 (5) ◽  
pp. 1282-1287 ◽  
Author(s):  
David Pestaña ◽  
Elena Espinosa ◽  
Julio R. Sangüesa-Molina ◽  
Raquel Ramos ◽  
Elia Pérez-Fernández ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Intensive Care Unit Mortality ◽  
Sepsis Bundle

scholarly journals Impact of Sepsis Identification and Treatment Time on In-Hospital Mortality, Length of Stay, and Hours in the Intensive Care Unit

2021 ◽  
Author(s):  
Sylvia EK Sudat
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Length Of Stay ◽  
Mortality Reduction ◽  
Sepsis Screening ◽  
The Impact

Objective: The objective of this study was to examine the impact of timely treatment and identification of sepsis on patient outcomes at Sutter Health, a mixed-payer healthcare system in northern California, US. Methods: This observational, retrospective analysis considered electronic health record (EHR) data for individuals who presented with sepsis during 2016-17 at any of Sutter Health's 22 emergency departments (ED). Impacts were assessed for the timing of broad-spectrum antibiotic and intravenous (IV) fluid initiation, first vital signs, sepsis screening, and lactate results. Outcomes were in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) hours for patients discharged alive. Results: The final sample size was 35,847 (N=9,638 severe sepsis, N=5,309 septic shock). Early fluid initiation had the largest estimated impacts: a mortality reduction of 2.85%[2.03%,3.68%] overall and 2.94%[1.44%,4.48%] for severe sepsis (within 1 hour of sepsis presentation), and 14.66%[9.23%,20.07%] for septic shock (within 3 hours); reduced LOS (days) 1.39[1.08,1.71] overall, 2.30[1.31,3.21] severe sepsis, 3.07[1.21,4.94] septic shock; and fewer ICU hours 25.93[16.95,34.66] overall, 35.06[14.7,56.99] severe sepsis, 41.99[15.70,70.68] septic shock (within 3 hours). Sepsis screening within 30 minutes was also associated with mortality reductions (3.88%[2.96%,4.90%] overall, 1.74%[0.08%,3.50%] severe sepsis, 6.78%[3.12%,10.33%] septic shock). The greatest improvement opportunity was estimated for joint initiation of antibiotics and IV fluids, with a modest additional mortality reduction of 0.80%[0.47%,1.17%] overall, 0.77%[0.34%,1.19%] severe sepsis, 2.94%[1.83%,3.97%] septic shock; LOS reduction of 0.37[0.28,0.46] overall, 0.29[0.17,0.43] severe sepsis, 0.25[0.01,0.51] septic shock (within 1 hour); ICU hours reduction of 4.85[3.26,6.57] overall, 5.07[2.55,7.67] severe sepsis, 3.85[1.69,6.24] septic shock (within 3 hours).

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