Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis

Dhooria, Sahajal; Sehgal, Inderpaul Singh; Agarwal, Ritesh

doi:10.1056/nejmc1708979

Cited by 5 publications

(1 citation statement)

References 11 publications

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“…Assessment of microvascular perfusion and guided resuscitation are of key importance, with common laboratory markers used by ICU physicians being peripheral lactate and central venous oxygen saturation (ScvO 2 ) [66]. Lactate levels and ScvO 2 levels are strongly linked to outcome [67,68]. These markers can be easily obtained on the ward.…”

Section: Assessment Of Microvascular Perfusion With Lactate Scvo2mentioning

confidence: 99%

Clinical Approach to the Patient in Critical State Following Immunotherapy and/or Stem Cell Transplantation: Guideline for the On-Call Physician

Constantinescu

Bodolea

Pașca

et al. 2019

JCM

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: The initial management of the hematology patient in a critical state is crucial and poses a great challenge both for the hematologist and the intensive care unit (ICU) physician. After years of clinical practice, there is still a delay in the proper recognition and treatment of critical situations, which leads to late admission to the ICU. There is a much-needed systematic ABC (Airway, Breathing, Circulation) approach for the patients being treated on the wards as well as in the high dependency units because the underlying hematological disorder, as well as disease-related complications, have an increasing frequency. Focusing on score-based decision-making on the wards (Modified Early Warning Score (MEWS), together with Quick Sofa score), active sepsis screening with inflammation markers (C-reactive protein, procalcitonin, and presepsin), and assessment of microcirculation, organ perfusion, and oxygen supply by using paraclinical parameters from the ICU setting (lactate, central venous oxygen saturation (ScVO2), and venous-to-arterial carbon dioxide difference), hematologists can manage the immediate critical patient and improve the overall outcome.

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Section: Assessment Of Microvascular Perfusion With Lactate Scvo2mentioning

confidence: 99%

Clinical Approach to the Patient in Critical State Following Immunotherapy and/or Stem Cell Transplantation: Guideline for the On-Call Physician

Constantinescu

Bodolea

Pașca

et al. 2019

JCM

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Regional differences in the treatment of refractory vasodilatory shock using Angiotensin II in High Output Shock (ATHOS-3) data

Abril

Khanna

Kroll

et al. 2019

Journal of Critical Care

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Low Versus High Blood Pressure Targets in Critically Ill and Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials*

D’Amico,

Pruna,

Putowski

et al. 2024

Critical Care Medicine

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Objectives: Hypotension is associated with adverse outcomes in critically ill and perioperative patients. However, these assumptions are supported by observational studies. This meta-analysis of randomized controlled trials aims to compare the impact of lower versus higher blood pressure targets on mortality. Data Sources: We searched PubMed, Cochrane, and Scholar from inception to February 10, 2024. Study Selection: Randomized trials comparing lower versus higher blood pressure targets in the management of critically ill and perioperative settings. Data Extraction: The primary outcome was all-cause mortality at the longest follow-up available. This review was registered in the Prospective International Register of Systematic Reviews, CRD42023452928. Data Synthesis: Of 2940 studies identified by the search string, 28 (12 in critically ill and 16 in perioperative settings) were included totaling 15,672 patients. Patients in the low blood pressure target group had lower mortality (23 studies included: 1019/7679 [13.3%] vs. 1103/7649 [14.4%]; relative risk 0.93; 95% CI, 0.87–0.99; p = 0.03; I 2 = 0%). This corresponded to a 97.4% probability of any increase in mortality with a Bayesian approach. These findings were mainly driven by studies performed in the ICU setting and with treatment lasting more than 24 hours; however, the magnitude and direction of the results were similar in the majority of sensitivity analyses including the analysis restricted to low risk of bias studies. We also observed a lower rate of atrial fibrillation and fewer patients requiring transfusion in low-pressure target groups. No differences were found in the other secondary outcomes. Conclusions: Based on pooled randomized trial evidence, a lower compared with a higher blood pressure target results in a reduction of mortality, atrial fibrillation, and transfusion requirements. Lower blood pressure targets may be beneficial but there is ongoing uncertainty. However, the present meta-analysis does not confirm previous findings and recommendations. These results might inform future guidelines and promote the study of the concept of protective hemodynamics.

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Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis

Cited by 5 publications

References 11 publications

Clinical Approach to the Patient in Critical State Following Immunotherapy and/or Stem Cell Transplantation: Guideline for the On-Call Physician

Clinical Approach to the Patient in Critical State Following Immunotherapy and/or Stem Cell Transplantation: Guideline for the On-Call Physician

Regional differences in the treatment of refractory vasodilatory shock using Angiotensin II in High Output Shock (ATHOS-3) data

Low Versus High Blood Pressure Targets in Critically Ill and Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials*

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