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Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To evaluate current evidence on the utility of hydrocortisone, ascorbic acid and thiamine (HAT) therapy for the management of septic shock. Summary The following keyword search terms were utilized in PubMed to identify relevant articles: ascorbic acid, thiamine, hydrocortisone, shock, and critical care. Articles relevant to HAT therapy in patients with septic shock were selected. Retrospective cohorts and randomized controlled trials were included in this review; case reports/series were excluded. Data from included studies illustrating the use of HAT therapy for the management of sepsis and septic shock, including data on time to HAT therapy initiation, severity of illness at baseline, duration of vasopressor therapy, progression of organ failure, and mortality, were evaluated. Conclusion The utilization of HAT therapy for the management of sepsis and septic shock remains controversial. Hemodynamic benefits have been shown to be most pronounced when HAT therapy is initiated earlier. Future studies directed at earlier initiation may be necessary to confirm this theory.

INTRODUCTION:Catecholamine-refractory shock is associated with high mortality. Angiotensin II has been proposed as an alternative agent due to its unique mechanism of action. Multiple studies have shown hemodynamic benefits with angiotensin II initiation in catecholamine-resistant shock. However, the effects of angiotensin II on vasopressor duration have not been adequately assessed. The purpose of this study was to evaluate the impact of angiotensin II in patients with refractory septic shock. METHODS:This was a single-centered, retrospective, before-after cohort. The outcomes and clinical course of septic patients in the "AT-II" group receiving angiotensin II from September 1, 2020 to February 28, 2021 were compared with the "non-AT-II" group not receiving angiotensin II during the preceding months from January 1, 2019 to August 31, 2020. Adults diagnosed with septic shock receiving > 0.2 mcg/kg/min norepinephrine equivalent doses (NED) and broad-spectrum antibiotics were evaluated. The primary outcome was time to vasopressor discontinuation. Secondary outcomes included mean change in SOFA score at 48 hours, ICU length of stay (LOS), in-hospital mortality, need for renal replacement therapy, number of vasopressors, and incidence of venous thromboembolism at 30 days.

INTRODUCTION:Portal venous gas and pneumatosis intestinalis are radiologic findings most commonly associated with bowel ischemia and necrosis. Given the high mortality rate associated with bowel necrosis, many patients are immediately evaluated for exploratory laparotomy. The following case represents a rare example of benign portal venous gas and pneumatosis intestinalis and describes the medical management thereof.