Search

Objectives: The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials to investigate whether IV high-dose vitamin C improves the short-term mortality of patients with sepsis.Design: This study is a systematic review and meta-analysis of randomized controlled trials. We searched EMBASE, the Cochrane Central Register of Controlled Trials, and MEDLINE for randomized controlled trials that met inclusion criteria. The protocol was registered at the University hospital Medical Information Network Clinical Trials Registry (UMIN000040528). All analyses were presented with the use of random-effects models. The primary outcome was short-term mortality defined as 28-day, 30-day, or in-hospital mortality.Patients: Two authors independently evaluated the following eligibility criteria: 1) randomized controlled trial, 2) patients with sepsis aged ≥18 years, and 3) received intravenous high-dose vitamin C in addition to standard of care, or standard of care alone. Then, two authors independently extracted the selected patient and study characteristics and outcomes from studies that met above eligibility criteria.Measurements and Main Results: Eleven randomized controlled trials (n = 1,737 patients) were included in this meta-analysis. High-dose IV vitamin C was not associated with a significantly lower short-term mortality (risk ratio, 0.88; 95% CI, 0.73-1.06; p = 0.18; I2 = 29%) but was associated with a significantly shorter duration of vasopressor use (standardized mean difference, -0.35; 95% CI, -0.63 to -0.07; p < 0.01; I2 = 80%) and a significantly greater decline in the Sequential Organ Failure Assessment score at 72-96 hours (standardized mean difference, -0.20; 95% CI, -0.32 to -0.08; p < 0.01; I2 = 16%). One study reported significant association with hypernatremia, but adverse effects were rare, and high-dose vitamin C is deemed relatively safe.Conclusions: In this meta-analysis, the use of IV high-dose vitamin C in patients with sepsis was not associated with lower short-term mortality although it was associated with significantly shorter duration of vasopressor use and greater decline in the Sequential Organ Failure Assessment score at 72-96 hours. [ABSTRACT FROM AUTHOR]

Objectives: Clinicians often encounter adult patients with septic shock who fail to respond to fluid therapy and vasopressors. There is an increasing interest in venoarterial extracorporeal membranous oxygenation in the treatment of patients with septic shock, but its outcomes and safety remain unclear. The aim of this study is to describe in-hospital mortality and complication rate in adult patients with septic shock who underwent venoarterial extracorporeal membranous oxygenation, and to identify patients who may potentially benefit from venoarterial extracorporeal membranous oxygenation.Data Sources: The protocol for this systematic review was registered at International Prospective Register of Systematic Reviews (CRD42018098848). We searched MEDLINE, Embase, and Igaku Chuo Zasshi for studies of any design in which patients with septic shock were treated with venoarterial extracorporeal membranous oxygenation. Our search was updated on October 6, 2019.Study Selection: Two independent reviewers assessed whether titles and abstracts met the eligibility criteria. Studies were included when patients met the following criteria: 1) age 18 years old or older; 2) septic shock; and 3) treated with venoarterial extracorporeal membranous oxygenation as hemodynamic support. When there were disagreements between reviewers, the full text was reviewed, and discussion was continued until a consensus was reached.Data Extraction: Two authors independently extracted the selected patient and study characteristics and outcomes.Data Synthesis: A total of 6,457 studies were screened. Six retrospective studies were included. The in-hospital mortality rate of patients with septic shock who underwent venoarterial extracorporeal membranous oxygenation was 76.7% (188/245). Four studies provided cardiac function with left ventricular ejection fraction and/or cardiac index. In two of these four studies where median left ventricular ejection fraction and cardiac index were 16.0% and 1.3 L/min/m and median left ventricular ejection fraction and mean cardiac index were 30.0% and 2.4 L/min/m, respectively, the in-hospital mortalities were markedly lower (14.8% and 28.6%, respectively) than the other two studies (78.1% and 91.5%, respectively) that included populations with median left ventricular ejection fraction of 25.0% and mean cardiac index of 2.1 L/min/m. Complications were reported in five studies (39 events/174 cases), hemorrhage (22 events/174 cases) being the most common.Conclusions: Venoarterial extracorporeal membranous oxygenation remains a controversial treatment strategy in septic shock. The reported in-hospital mortality rates in patients with sepsis-induced cardiogenic shock who underwent venoarterial extracorporeal membranous oxygenation were quite inconsistent. There is a need for well-designed studies to assess the benefit and safety of venoarterial extracorporeal membranous oxygenation in patients with sepsis-induced cardiogenic shock. [ABSTRACT FROM AUTHOR]

Sepsis, septic shock, and transthoracic echocardiogram (TTE) were identified using the International Classification of Diseases, Tenth Revision codes. B Introduction: b While the current Surviving Sepsis Campaign Guidelines suggests echocardiogram for the hemodynamic assessment in sepsis and septic shock, the evidence to support the utility of echocardiogram has been limited. B Conclusions: b This study using the large national database described that the use of TTE was associated with significantly lower in-hospital mortality in patients with septic shock while it was not in patients with sepsis without septic shock. [Extracted from the article]

B Introduction: b Sedation is an essential component of critical care for patients undergoing mechanical ventilation. Thus, this systematic review and meta-analysis aimed to clarify whether treatment with dexmedetomidine could reduce the mortality on top of intensive care unit length of stay, and ventilator-free days in patients with sepsis. However, more recent large randomized-controlled trials (RCTs) in patients with sepsis reported that dexmedetomidine use was not associated with improved outcomes (Shehabi et al. 2019 and Hughes et al. 2021). [Extracted from the article]

After controlling for baseline characteristics, past medical history, and vasopressor requirements within the first 24 hours of septic shock, late-onset septic shock, compared to early-onset septic shock, was associated with significantly higher in-hospital mortality [odds ratio (OR): 2.22, 95% confidence interval (CI): 1.72 - 2.85, p < 0.01]. B Conclusion: b In this study, late-onset septic shock (> 7days) after hospital admission was associated with a significantly higher in-hospital mortality compared to early-onset septic shock. B Result: b A total of 3,508 patients with septic shock (2,821 early-onset and 687 late-onset septic shock) were included. [Extracted from the article]

This study aimed to compare the maximum VIS and norepinephrine equivalent (NEE) dose in the first 24 hours of septic shock for the prediction of in-hospital mortality and explore the optimal definition of refractory septic shock. NEE dose showed significantly better prediction accuracy than VIS for in-hospital mortality [NEE dose; area under the curve (AUC): 0.78, 95% confidence interval (CI): 0.76-0.79 versus. [Extracted from the article]

Despite maximal care, the patient's condition continued to decline and the patient died of multi-organ failure on the 12th day of admission. B Results: b Strongyloides Hyperinfection Syndrome (SHS) typically occurs in immunocompromised patients. Although DAH secondary to SHS is rare, SHS is life-threatening and SHS should be included in work-up for DAH, especially among immunocompromised patients. [Extracted from the article]

Although previous meta-analyses suggested that LV systolic dysfunction defined by reduced LV ejection fraction in patients with sepsis was not associated with higher or lower mortality, studies included in these meta-analyses did not exclude patients with underlying myocardial diseases. Sepsis-induced cardiomyopathy (SICM), which can be defined as new-onset left ventricular (LV) systolic dysfunction, is one of such sepsis-induced organ failures. All studies reported the prevalence of SICM in patients with sepsis and the pooled prevalence of SICM was 28% [95% confidence interval (CI), 23 to 34%]. [Extracted from the article]

Similarly, there was no significant improvement in mortality amongst patients with solid-tumor malignancy (2011: 47.80% to 2020: 41.37%, p=0.913) and non-solid tumor (2011: 56% to 2020: 42.35%, p=0.393). We report the trend in survival over the last decade for patients with septic shock without malignancy and those with septic shock and malignancy. [Extracted from the article]

Further research is needed to establish the utility of these distinct LV systolic function phenotypes in outcomes of patient with sepsis and septic shock. B Conclusions: b In this analysis of systolic function among patients with sepsis, (LVEF >= 55% & MASV < 8.5 cm/sec) and (LVEF < 55 & MASV < 8.5 cm/sec) phenotypes were associated with higher mortality. The ICU mortality was 28% for the phenotype; 36% for the phenotype; 29% for the phenotype; and 35% for the phenotype. [Extracted from the article]

B Introduction: b Septic shock patients have heterogeneous and dynamic cardiovascular dysfunction. B Methods: b This retrospective study included patients with septic shock receiving vasopressin as a catecholamine adjunct who had an echo performed after shock onset and prior to vasopressin initiation. Patients with LV systolic dysfunction were less frequently vasopressin responsive (with LV dysfunction: 10/27 [37%] vs. without LV dysfunction: 62/102 [61%], absolute difference -24%; 95% CI -44% to -3%). [Extracted from the article]