Evaluation of Evidence, Pharmacology, and Interplay of Fluid Resuscitation and Vasoactive Therapy in Sepsis and Septic Shock

Barlow, Brooke; Bissell, Brittany D

doi:10.1097/shk.0000000000001783

Cited by 4 publications

(5 citation statements)

References 84 publications

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“…However, norepinephrine weaning in septic shock is not simply the reverse of the acute phase management. In the acute phase, it has been shown that the cardiovascular equilibrium depends on the underlying disease (i.e., sepsis vs. non sepsis), the type and dose of medications (inotrope, vasopressor, or both), and the fluid therapy provided during the resuscitation phase ( 1 , 11 , 13 , 19 – 21 ). Several studies have demonstrated that norepinephrine can act as a fluid challenge by increasing venous return and cardiac pre-load ( 8 , 9 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…The decrease in blood pressure may be explained by the effects of norepinephrine on cardiac function and arterial load ( 6 , 12 , 19 , 20 ). We did observe a decrease in CFI and ventricular elastance, which are two parameters of cardiac systolic function.…”

Section: Discussionmentioning

confidence: 99%

“…We did observe a decrease in CFI and ventricular elastance, which are two parameters of cardiac systolic function. Studies have demonstrated that the administration of a low dose of norepinephrine can increase left ventricular function, CI, and blood pressure ( 19 , 21 ). These alterations may partially explain the decrease in blood flow and thus in blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Arterial Hypotension Following Norepinephrine Decrease in Septic Shock Patients Is Not Related to Preload Dependence: A Prospective, Observational Cohort Study

et al. 2022

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BackgroundThe optimal management of hypotensive patients during norepinephrine weaning is unclear. The primary study aim was to assess the ability of preload dependence to predict hypotension following norepinephrine weaning. The secondary aims were to describe the effect of norepinephrine weaning on preload dependence, and the cardiovascular effects of fluid expansion in hypotensive patients following norepinephrine weaning.Materials and MethodsThis was a prospective observational monocentric study. We included PiCCO®-monitored patients with norepinephrine-treated septic shock, for whom the physician decided to decrease the norepinephrine dosage during the de-escalation phase. Three consecutive steps were evaluated with hemodynamic measurements: baseline, after norepinephrine decrease, and after 500 mL fluid expansion.ResultsForty-five patients were included. Preload dependence assessed by stroke volume changes following passive leg raising was not predictive of pressure response to norepinephrine weaning [AUC of 0.42 (95%CI: 0.25–0.59, p = 0.395)]. After fluid expansion, there was no difference in the prior preload dependence between pressure-responders and non-pressure-responders (14 vs. 13%, p = 1). The pressure response to norepinephrine decrease was not associated with pressure response after fluid expansion (40 vs. 23%, p = 0.211).ConclusionHypotension following norepinephrine decrease was not predicted by preload dependence, and there was no association between arterial hypotension after norepinephrine decrease and fluid response.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Arterial Hypotension Following Norepinephrine Decrease in Septic Shock Patients Is Not Related to Preload Dependence: A Prospective, Observational Cohort Study

et al. 2022

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“…It is uncertain whether restricted i.v. fluid volume and timing of initiation of vasopressor support in adult septic shock patients can reduce mortality and organ dysfunction, and whether the strategy is feasible (11). Currently, there is a lack of clinical evidence and no recommendation in relevant guidelines.…”

Section: Introductionmentioning

confidence: 99%

Restrictive Fluid Resuscitation in Septic Shock Patients Has Lower Mortality and Organ Dysfunction Rates Than Standard Therapy

Jiang,

Luo,

Liu

et al. 2023

Shock

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Background The influence of restrictive fluid resuscitation and the early administration of vasopressors on the clinical outcomes in patients with septic shock is not fully understood. The purpose of this study was to evaluate the effects of restrictive fluid management on mortality and organ dysfunction in patients with septic shock. Methods This study included consecutive patients with septic shock in need of fluid resuscitation. Based on the fluid management provided in the initial resuscitation phase, a comparison was made between a restrictive group and a standard fluid management group. The primary outcome was in-hospital death, while secondary outcomes included organ dysfunction and other adverse events. Results A total of 238 patients were included in this study. Restrictive fluid management was administered to 59.2% of patients, while 40.8% received standard fluid management. Restrictive resuscitation was associated with a lower in-hospital mortality rate (24.8% vs. 52.6%), as well as a shorter median ICU stay (8.0 vs. 11.0 days). The restrictive strategy was associated with a significantly lower prevalence of new-onset acute kidney injury (25.5% vs. 51.5%) and a decrease in the incidence of renal replacement therapy (20.6% vs. 40.2%). The standard group had a higher risk of the need for mechanical ventilation and a significantly lower median number of days without a ventilator than the restrictive group. The median duration of vasopressor-free days in the restrictive group was significantly longer than that in the standard group (25.0 vs. 18.0). The administration rate of inotropes in the restrictive group was significantly lower than that in the standard group. A multivariate logistic regression model showed that restrictive fluid management (OR 0.312; 95% CI 0.098–0.994) and vasopressor-free days (OR 0.807; 95% CI 0.765–0.851) protect against in-hospital death, whereas APACHE II scores (OR 1.121; 95% CI 1.018–1.234) were independent risk factors for in-hospital death. Conclusions Restrictive fluid resuscitation and early vasopressor protocol in patients with septic shock are associated with better outcomes, indicating that this regimen is feasible and safe.

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“…We finish up the October issue of SHOCK with a detailed review about fluid resuscitation and vasoactive therapy in sepsis and septic shock. Barlow and Bissell (20) team up to provide an evaluation of evidence and pharmacology of vasoactive therapy and fluid administration in sepsis and septic shock, with specific insight into the physiologic interplay of these agents. A total of 1,022 citations were reviewed with only relevant clinical data extracted.…”

mentioning

confidence: 99%

What's New in Shock, October 2021?

Castro‐Faria‐Neto¹

2021

Shock

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Evaluation of Evidence, Pharmacology, and Interplay of Fluid Resuscitation and Vasoactive Therapy in Sepsis and Septic Shock

Cited by 4 publications

References 84 publications

Arterial Hypotension Following Norepinephrine Decrease in Septic Shock Patients Is Not Related to Preload Dependence: A Prospective, Observational Cohort Study

Arterial Hypotension Following Norepinephrine Decrease in Septic Shock Patients Is Not Related to Preload Dependence: A Prospective, Observational Cohort Study

Restrictive Fluid Resuscitation in Septic Shock Patients Has Lower Mortality and Organ Dysfunction Rates Than Standard Therapy

What's New in Shock, October 2021?

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