Refractory Septic Shock (Part 2)

Refractory shock is the shock that does not respond to vasopressor therapy. Refractory shock with a short-term mortality rate of more than 50% is diagnosed in 6-7% of critically ill patients. There is an objective need to Investigate methods of intensive therapy for refractory septic shock.The objective of the study: to analyze literature data on the intensive care of refractory septic shock.Results. The second part of the article analyzes 37 studies, both Russian and foreign ones devoted to the intensive care of refractory shock. At present, based on the analysis of the publication, it is impossible to draw reasonable conclusions about the advantage of one or another method of intensive therapy for refractory shock (veno-venous hemofiltration, the use of angiotensin II and vasopressin, as well as methylene blue, vitamin B12, ECMO) over basic therapy.

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Refractory septic shock (Part 1)

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2021-18-2-77-83 ◽

2021 ◽

Vol 18 (2) ◽

pp. 77-83

Author(s):

L. L. Plotkin

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Metabolic Acidosis ◽

Adjuvant Therapy ◽

Intensive Therapy ◽

Underlying Disease ◽

Shock Treatment ◽

Short Term ◽

Refractory Septic Shock ◽

Liquid Bolus

Refractory septic shock develops in 6–7% of sepsis patients with short-term lethality rate of more than 50%. It is necessary to assess the effectiveness of intensive therapy methods used in this case.The objective of the review: to analyze publications on the intensive care of refractory septic shock.Results. 56 studies published in the period from January 1, 1990 to September 1, 2020 were analysed, they reflect the effectiveness of some methods used for management of refractory septic shock (treatment of the underlying disease, liquid bolus, the use of norepinephrine, adjuvant therapy, management of metabolic acidosis). The second part of this article will reflect the evaluation of the effectiveness of other approaches to the treatment of this complication.

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Validation of the pediatric refractory septic shock definition: post hoc analysis of a controlled trial

Annals of Intensive Care ◽

10.1186/s13613-021-00822-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Luc Morin ◽

Karthik Narayanan Ramaswamy ◽

Muralidharan Jayashree ◽

Arun Bansal ◽

Karthi Nallasamy ◽

...

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Receiver Operating Curve ◽

Double Blind ◽

Post Hoc Analysis ◽

Prognostic Accuracy ◽

Refractory Septic Shock ◽

Post Hoc

Abstract Background The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) developed and validated a definition of pediatric refractory septic shock (RSS), based on two septic shock scores (SSS). Both bedside SSS (bSSS) and computed SSS (cSSS) were found to be strongly associated with mortality. We aimed at assessing the accuracy of the RSS definition on a prospective cohort from India. Methods Post hoc analysis of a cohort issued from a double-blind randomized trial that compared first-line vasoactive drugs in children with septic shock. Sequential bSSS and cSSS from 60 children (single-center study, 53% mortality) were analyzed. The prognostic value of the ESPNIC RSS definition was tested for 28-day all-cause mortality. Results In this septic shock cohort, RSS was diagnosed in 35 patients (58.3%) during the first 24 h. Death occurred in 30 RSS patients (85.7% mortality) and in 2 non-RSS patients (8% mortality), OR = 60.9 [95% CI: 10.5–676.2], p < 0.001 with a median delay from sepsis onset of 3 days [1.0–6.7]. Among patients diagnosed with RSS, the mortality was not significantly different according to vasopressors randomization. Diagnosis of RSS with bSSS and cSSS had a high discrimination for death with an area under the receiver operating curve of 0.916 [95% CI: 0.843–0.990] and 0.925 [95% CI: 0.845–1.000], respectively. High prognostic accuracy of the bSSS was found in the first hours following intensive care admission. The best interval of prognostication occurs after the 12th hour following treatment initiation (AUC 0.973 [95% CI: 0.925–1.000]). Conclusions The ESPNIC refractory septic shock definition accurately identifies, within the first 6 h of septic shock management, children with lethal outcome.

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Abdominal Obesity and Short-term Mortality in Critically Ill Patients with Sepsis: A Retrospective Cohort Study Based on the MIMIC-IV Database

10.21203/rs.3.rs-1040005/v1 ◽

2021 ◽

Author(s):

Zhou Lv ◽

Minglu Gu ◽

Miao Zhou ◽

Yanfei Mao ◽

Lai Jiang

Keyword(s):

Metabolic Syndrome ◽

Cohort Study ◽

Intensive Care ◽

Abdominal Obesity ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Obese Patients ◽

Short Term ◽

Icu Admission ◽

Short Term Mortality

Abstract Purpose: Multiple studies have demonstrated an obesity paradox such that obese septic patients have a lower mortality rate and a relatively favorable prognosis. However, less is known on the association between abdominal obesity and short-term mortality in patients with sepsis. We conducted this study to determine whether the obesity-related survival benefit remains among abdominal obese patients.Methods: A retrospective cohort study was conducted using data derived from the Medical Information Mart for Intensive Care IV database. Septic patients (≥18 years) with or without abdominal obesity of first intensive care units (ICU) admission in the database were enrolled. The primary outcome was mortality within 28 days of ICU admission and multivariable logistic regression analyses were employed to assess any association between abdominal obesity and the outcome variable.Results: A total of 21534 patients were enrolled finally, the crude 28-day mortality benefit after ICU admission was not observed in patients with abdominal obesity (15.8% vs. 15.3%, p=0.32). In the extended multivariable logistic models, the odds ratio (OR) of abdominal obesity was significantly inversed after incorporating metabolic variables into the logistic model (OR range 1.094-2.872, p = 0.02). The subgroup analysis showed interaction effects in impaired fasting blood glucose/diabetes and metabolic syndrome subgroups (P = 0.001 and <0.001, respectively). In the subgroups of blood pressure, high-density lipoprotein cholesterol, and triglyceride level, no interaction was detected in the association between abdominal obesity and mortality. After propensity score matching, 6523 pairs of patients were selected. The mortality significantly higher in the abdominal obesity group (17.0% vs. 14.8%, p = 0.015). Notably, the non-abdominal obese patients were weaned off vasopressors and mechanical ventilation more quickly than those in the abdominal obesity group (vasopressor‑free days on day 28 of 27.0 vs. 26.8, p < 0.001; ventilation-free days on day 28 of 26.7 vs. 25.6, p < 0.001).Conclusion: Abdominal obesity was associated with increased risk of adjusted sepsis-related mortality within 28 days after ICU admission and was partially mediated through metabolic syndrome components.

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A Model to Predict Short-term Mortality in Patients with Cirrhosis in Intensive Care

The American Journal of Gastroenterology ◽

10.14309/00000434-201110002-00354 ◽

2011 ◽

Vol 106 ◽

pp. S139-S140

Author(s):

Hemant Chatrath ◽

Haripriya Maddur ◽

Karen Wolf ◽

Raj Vuppalanchi ◽

Hwan Yoo ◽

...

Keyword(s):

Intensive Care ◽

Short Term ◽

Short Term Mortality

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Subsequent Multidrug-Resistant Bacteremia Is a Risk Factor for Short-Term Mortality of Patients with Ventilator-Associated Pneumonia Caused by Acinetobacter baumannii in Intensive Care Unit

Chinese Medical Journal ◽

10.4103/0366-6999.223859 ◽

2018 ◽

Vol 131 (3) ◽

pp. 361-363 ◽

Cited By ~ 1

Author(s):

Mo-Han Ju ◽

Yu-Long Yao ◽

Chun-Ling Du ◽

Shu Chen ◽

Yuan-Lin Song

Keyword(s):

Intensive Care Unit ◽

Risk Factor ◽

Intensive Care ◽

Acinetobacter Baumannii ◽

Multidrug Resistant ◽

Ventilator Associated Pneumonia ◽

Short Term ◽

Short Term Mortality

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METHYLENE BLUE IN REFRACTORY SEPTIC SHOCK

CHEST Journal ◽

10.1016/j.chest.2020.09.155 ◽

2020 ◽

Vol 158 (4) ◽

pp. A2558

Author(s):

Mouhanned Eliliwi ◽

Jennifer Meyfeldt ◽

Stephanie Hart ◽

Eliot Friedman

Keyword(s):

Septic Shock ◽

Methylene Blue ◽

Refractory Septic Shock

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Mortality of Adult Patients With Cancer Admitted to an Intensive Care Unit in Chile: A Prospective Cohort Study

Journal of Global Oncology ◽

10.1200/jgo.18.00091 ◽

2018 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Sergio Panay ◽

Carolina Ruiz ◽

Marcelo Abarca ◽

Bruno Nervi ◽

Ignacio Salazar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prospective Cohort ◽

Admission Policy ◽

Short Term ◽

Assessment Scores ◽

Patients With Cancer ◽

Failure Assessment ◽

Short Term Mortality ◽

The Mean

Purpose Increasing numbers of reports have shown acceptable short-term mortality of patients with cancer admitted into the intensive care unit (ICU). The aim of this study was to determine the mortality of critically ill patients with cancer admitted to the ICU in a general hospital in Chile. Materials and Methods This was a prospective cohort trial in which we included all patients with cancer admitted to the ICU between July 2015 and September 2016. Demographic, physiologic, and treatment data were registered, and survival at 30 days and 6 months was evaluated. A prespecified subgroup analysis considering the admission policy was performed. These subgroups were (1) ICU admission for full code management and (2) ICU trial (IT). Results During the study period, 109 patients with cancer were included. Seventy-nine patients were considered in the full code management group and 30 in the IT. The mean age of patients was 60 years (standard deviation [SD], 15), and 56% were male. Lymphoma was the most frequent malignancy (17%), and 59% had not received cancer treatment because of a recent diagnosis. The mean Acute Physiology and Chronic Health Evaluation and Sequential-Related Organ Failure Assessment scores were 22.2 (SD, 7.3) and 7 (SD, 3), respectively. There were no differences in vasopressor, fluid, or transfusion requirements between subgroups. Lactate levels, Sequential-Related Organ Failure Assessment scores (day 1, 3, and 5), complications, and ICU length of stay were similar. In the entire cohort, 30-day and 6-month mortality was 47% and 66%, respectively. There was no difference in mortality between subgroups according to the admission policy. Conclusion Patients admitted to the ICU in a developing country are at high risk for short-term mortality. However, there is a relevant subgroup that achieves 6-month survival, even among patients who undergo an IT.

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