Effects of combination therapy with Shenfu Injection in critically ill patients with septic shock receiving mechanical ventilation: A multicentric, real-world study

Abstract

Background: Septic shock has increasingly become a cause of death threatening human survival. Shenfu Injection (SFI), a patented Chinese medicine, has been widely used in the treatment of patients with sepsis and cardiovascular diseases domestically. We sought to examine whether combination therapy with SFI can improve clinical outcomes in critically ill patients undergoing mechanical ventilation (MV).Methods: This real-world, multicenter retrospective trial enrolled consecutive adult patients with sepsis requiring MV from four medical/surgical intensive care units (ICUs) in China between August 2016 and September 2021. Patients were identified from the medical information department database of each center and assigned to either of two groups (SFI or control) on the basis of the initial treatment received. The primary outcome was 28-day all-cause mortality, and the durations of vasopressor therapy and MV, the ICU length of stay, and costs were assessed as secondary outcomes. Subsequently, we performed a meta-analysis of randomized controlled trials (RCTs) on SFI published before July 2021 to verify our conclusions.Results: 2311 mechanically ventilated patients with septic shock (1128 patients in the SFI group and 1183 in the control group) were analyzed. The survival probability during the first 28 days after admission in the SFI group was greater than that in the control group [p < 0.01 by log-rank test; hazard ratio (HR), 0.56; 95% confidence interval (CI), 0.39–0.72]. Patients in the SFI group also experienced a significantly reduced duration of vasopressor therapy [7.28 (95% CI, 6.14–8.42) vs. 12.06 (95% CI, 10.71–13.41) days, p < 0.001], more ventilator-free days [6.49 (95% CI, 5.42–7.55) vs. 10.84 (95% CI, 9.59–12.09) days, p < 0.001], a shorter ICU length of stay [18.48 (95% CI, 17.59–19.38) vs. 23.77 (95% CI, 22.47–25.07) days, p < 0.001], and more time free from organ failure [14.23 (95% CI, 12.94–15.52) vs. 19.07 (95% CI, 16.09–22.05) days, p < 0.001]. No major adverse effects were reported in either group.Conclusion: Among critically ill patients requiring MV, combination therapy with SFI can improve the survival probability without any obvious adverse reactions.

Shenfu injection: a review of pharmacological effects on cardiovascular diseases

“…SFI ( Figure 1 ) is widely used in China to treat numerous ailments, including shock ( Zhang X. et al, 2020 ; Wang et al, 2022 ; Zhang and Li, 2023 ), pulmonary fibrosis ( Liu et al, 2021 ), sepsis ( Luo et al, 2021 ; Li X. et al, 2022 ; Xu et al, 2022 ), pneumonia ( Niu et al, 2021 ; Shi et al, 2022 ), cancer ( Gao and Zhang, 2023 ; Wen et al, 2023 ), cercerebral infarction ( Zhou et al, 2020 ), CVDs, and has shown promising results. With development of pharmacological research, SFI has been identified as an effective drug for the treatment of CVDs.This paper reviews the latest reports in the past 20 years (2003–2022) from PubMed, Web of Science, and National Knowledge Infrastructure (CNKI) using the keywords “Shenfu injection” and “cardiovascular diseases”.…”

Effect of Shenfu Injection on Myocardial Injury After Primary PCI for STEMI: The RESTORE Trial

“…Shenfu injection, a component-based Chinese medicine with “Yang”-restoring and “Qi”-tonifying property, is exacted from ginseng (Panax; family: Araliaceae) and aconite (Radix aconiti lateralis preparata, Aconitum carmichaeli Debx; family: Ranunculaceae) 15, 16 with ginsenosides and aconite alkaloids as the main active ingredients, containing 1 mg/ml Panax ginseng C.A. Mey and 2 mg/ml Aconitum Carmichaeli Debeaux 17, 18 . Shenfu injection exerts synergistic cardioprotective effect by forming a complex pharmacologic network directed to distinct signaling pathways within the cardiomyocyte, and it could improve the efficacy by the combination of multi-components and multitargets 17, 19 .…”

Comparison of esketamine and remifentanil in combination with propofol in patients with septic shock receiving invasive mechanical ventilation: a randomized controlled trial

“…Multiple organ dysfunction syndrome(MODS) is the most dangerous consequence of sepsis, caused by septic shock and an unchecked in ammatory response. Since the lung is the most severely affected organ in patients with sepsis, lung damage associated with sepsis is a frightening complication that severely results in a high mortality rate [4]. Almost half of the patients with septic shock develop acute lung injury (ALI) [5].…”