Evaluation of Vasopressor Exposure and Mortality in Patients With Septic Shock*

Roberts, Russel J.; Miano, Todd; Hammond, Drayton A.; Patel, Gourang; Chen, Jen-Ting; Phillips, Kristy M.; Lopez, Natasha; Kashani, Kianoush; Qadir, Nida; Cairns, Charles B.; Mathews, Kusum S.; Park, Pauline; Khan, Akram; Gilmore, James F.; Brown, Anne Rain; Tsuei, Betty J.; Handzel, Michele; Chang, Alfredo Lee; Duggal, Abhijit; Lanspa, Michael J.; Herbert, James T.; Martinez, Anthony; Tonna, Joseph E.; Ammar, Mahmoud; Nazer, Lama; Heavner, Mojdeh; Pender, Erin; Chambers, Lauren; Kenes, Michael; Kaufman, David A.; Downey, April; Brown, Brent; Chaykosky, Darlene; Wolff, Armand; Smith, Michael; Nault, Katie; Gong, Michelle N.; Sevransky, Jonathan; Lat, Ishaq

doi:10.1097/ccm.0000000000004476

Cited by 50 publications

(38 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As compared to the real clinical practice in our participating hospitals, less norepinephrine and more fluids can be given to class 2 patients on day 0, in order to achieve a better clinical outcome. This is consistent with some observations that treatment strategy with more fluid volume and lower vasopressor dose at 0–6 h is associated with improved mortality outcome [ 49 , 50 ]. Patients in class 2 are characterized by profound hypotension and poor tissue perfusion.…”

Section: Discussionsupporting

confidence: 92%

Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen

Ma¹,

Liu

Shen

et al. 2021

Crit Care

View full text Add to dashboard Cite

Background Septic shock comprises a heterogeneous population, and individualized resuscitation strategy is of vital importance. The study aimed to identify subclasses of septic shock with non-supervised learning algorithms, so as to tailor resuscitation strategy for each class. Methods Patients with septic shock in 25 tertiary care teaching hospitals in China from January 2016 to December 2017 were enrolled in the study. Clinical and laboratory variables were collected on days 0, 1, 2, 3 and 7 after ICU admission. Subclasses of septic shock were identified by both finite mixture modeling and K-means clustering. Individualized fluid volume and norepinephrine dose were estimated using dynamic treatment regime (DTR) model to optimize the final mortality outcome. DTR models were validated in the eICU Collaborative Research Database (eICU-CRD) dataset. Results A total of 1437 patients with a mortality rate of 29% were included for analysis. The finite mixture modeling and K-means clustering robustly identified five classes of septic shock. Class 1 (baseline class) accounted for the majority of patients over all days; class 2 (critical class) had the highest severity of illness; class 3 (renal dysfunction) was characterized by renal dysfunction; class 4 (respiratory failure class) was characterized by respiratory failure; and class 5 (mild class) was characterized by the lowest mortality rate (21%). The optimal fluid infusion followed the resuscitation/de-resuscitation phases with initial large volume infusion and late restricted volume infusion. While class 1 transitioned to de-resuscitation phase on day 3, class 3 transitioned on day 1. Classes 1 and 3 might benefit from early use of norepinephrine, and class 2 can benefit from delayed use of norepinephrine while waiting for adequate fluid infusion. Conclusions Septic shock comprises a heterogeneous population that can be robustly classified into five phenotypes. These classes can be easily identified with routine clinical variables and can help to tailor resuscitation strategy in the context of precise medicine.

show abstract

Section: Discussionsupporting

confidence: 92%

Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen

Ma¹,

Liu

Shen

et al. 2021

Crit Care

View full text Add to dashboard Cite

show abstract

“…Second, patients who came from the emergency department, other wards or ICU, or postoperative patients, may have received fluid resuscitation prior to ICU admission and were non-fluid-responsive; these patients needed higher dose vasopressor to improve MAP and tissue hypoperfusion, which leads to adverse effects 29 30 and higher mortality in patients with sepsis. 31 However, we failed to consider fluid input and output prior to ICU admission or in the operating theatre, which may affect outcomes, and our findings require future validation. In the sensitivity analysis, maximum FO was associated with an increased risk of in-hospital mortality in patients with or without shock, but patients with shock who needed more fluid resuscitation seemed to have a larger optimal range of fluid balance.…”

Section: Discussionmentioning

confidence: 87%

Dose–response association between fluid overload and in-hospital mortality in critically ill patients: a multicentre, prospective, observational cohort study

et al. 2020

View full text Add to dashboard Cite

ObjectivesFluid management is important in ensuring haemodynamic stability in critically ill patients, but can easily lead to fluid overload (FO). However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose–response relationship between FO and in-hospital mortality in critically ill patients.DesignMulticentre, prospective, observational study.SettingEighteen intensive care units (ICUs) of 16 tertiary hospitals in China.ParticipantsCritically ill patients in the ICU for more than 3 days.Primary outcome measures and analysesFO was defined as the ratio of the cumulative fluid balance (L) and initial body weight (kg) on ICU admission, expressed as a percentage. Maximum FO was defined as the peak value of FO during the first 3 days of ICU admission. Logistic regression models with restricted cubic splines were used to explore the pattern and magnitude of the association between maximum FO and risk of in-hospital mortality. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score on admission, main diagnosis on admission to ICU, comorbidities, time of maximum FO, mechanical ventilation, renal replacement therapy, use of vasopressors and centres were adjusted in multivariable analysis.ResultsA total of 3850 patients were included in the study, 929 (24.1%) of whom died in the hospital. For each 1% L/kg increase in maximum FO, the risk of in-hospital mortality increased by 4% (adjusted HR (aHR) 1.04, 95% CI 1.03 to 1.05, p<0.001). A maximum FO greater than 10% was associated with a 44% increased HR of in-hospital mortality compared with an FO less than 5% (aHR 1.44, 95% CI 1.27 to 1.67). Notably, we found a non-linear dose–response association between maximum FO and in-hospital mortality.ConclusionsBoth higher and negative fluid balance levels were associated with an increased risk of in-hospital mortality in critically ill patients.Trial registration numberChiCTR-ECH-13003934.

show abstract

“…According to the results, increasing the potency of vasopressors during the first 24 hours after septic shock was linked to an increase in mortality. This relationship changed depending on how much early fluid was given and when the vasopressor was titrated [ 20 ].…”

Section: Reviewmentioning

confidence: 99%

Sepsis Management, Controversies, and Advancement in Nanotechnology: A Systematic Review

Choudhary¹

2022

Cureus

View full text Add to dashboard Cite

Sepsis is a potentially dangerous infection that requires prompt identification and treatment. Emergency medicine physicians must grasp the clinical signs and laboratory results of direct and indirect organ failure, the source of infection management, and the criteria for treating sepsis and septic shock. The pathogenesis of sepsis is connected to inflammation and an excess of reactive oxygen and nitrogen species, which activate the pathogen-associated molecular pattern (PAMP)-pattern recognition receptor (PRR) and damageassociated molecular pattern (DAMP)-PRR signaling pathways. The development of rapid, sensitive, and precise techniques for sepsis diagnosis might be aided by nanotechnology, a part of nanomedicine. Nanoparticles (NPs) such as magnetic NPs, gold NPs, fluorescent (silica and quantum dots), and lipid-based NPs have all been discussed to contribute to the detection of sepsis-related microbial infections. Because of the intrinsic and unique features of these nano-sized systems, researchers are evaluating nanotechnologybased alternatives for sepsis control. Recent advances in nanotechnology-based technologies for sepsis detection and management are discussed in this study.Databases (PubMed, Medline, PMC, Google Scholar) were used to source various studies that were carried out on sepsis in terms of assessment, types, diagnosis, and treatment controversies, with more attention being given with a focus on the most recent data, principles, and management guidelines. Priority was also given to studies published within the last 11 years, using keywords such as "sepsis guidelines," "sepsis clinical," "septic risk factors," "sepsis and nano technology," "nano particles," "sepsis controversies," and "nano diagnostic" in the search. After a filtration process, the eight most relevant studies were selected to be included in this review. The filtration process included the use of both inclusion and exclusion criteria. The excluded studies were pediatric populations, obstetrical populations, and nanotechnology advancements dealing with other fields not relating to sepsis. The selected studies were also undertaken through a quality appraisal process using corresponding assessment tools. The selected articles were all highly informative about sepsis and the processes of diagnosis and treatment that are currently in use as well as those that are still being developed or implemented. Furthermore, we look at how nanomedicine in the application of nanomaterials can be employed to efficiently manage sepsis.

show abstract

Evaluation of Vasopressor Exposure and Mortality in Patients With Septic Shock*

Cited by 50 publications

References 35 publications

Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen

Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen

Dose–response association between fluid overload and in-hospital mortality in critically ill patients: a multicentre, prospective, observational cohort study

Sepsis Management, Controversies, and Advancement in Nanotechnology: A Systematic Review

Contact Info

Product

Resources

About