Shock Patients Research Articles

Use of oral midodrine for weaning off norepinephrine in patients with septic shock

BackgroundEarly administration of norepinephrine in septic shock patients is linked to better survival rates. However, vasopressor dependence often occurs during the recovery phase, delaying ICU discharge.ObjectivesA comparative study was conducted on patients admitted with a diagnosis of septic shock over 2 years regarding the use of oral midodrine in weaning them off norepinephrine.Patients and methodsThe population in this study included 100 patients admitted to the adult ICU department with septic shock between October 2016 and August 2018. Participants were divided into two cohorts: Group I was administered only IV norepinephrine, whereas Group II was given both IV norepinephrine and midodrine. Participants in the midodrine group were administered 10 mg of midodrine orally every 8 h.ResultsResults showed that patients not receiving oral midodrine had higher NE doses, longer NE infusion duration, extended NE weaning time, and increased ICU and hospital stay compared to those who did receive oral midodrine (p < 0.001). Our study indicates that oral midodrine was not a predictor of survival rate (p = 0.964).ConclusionsMidodrine may serve as a valuable adjunct for weaning from IV vasopressors in septic shock patients. Septic shock patients who received midodrine for IV norepinephrine weaning showed significantly lower NE doses, durations of NE infusion, and NE weaning times.

Advanced Markers for Hemodynamic Monitoring in Cardiogenic Shock and End-Stage Heart Failure: A Mini Review.

Right heart catheterization (RHC) provides critical hemodynamic insights by measuring atrial, ventricular, and pulmonary artery pressures, as well as cardiac output (CO). Although the use of RHC has decreased, its application has been linked to improved outcomes. Advanced hemodynamic markers such as cardiac power output (CPO), aortic pulsatility index (API), pulmonary artery pulsatility index (PAPi), right atrial pressure to pulmonary capillary wedge pressure ratio (RAP/PCWP) and right ventricular stroke work index (RVSWI) have been introduced to enhance risk stratification in cardiogenic shock (CS) and end-stage heart failure (HF) patients. CPO has emerged as a potent prognostic tool, with values below 0.6 Watts significantly associated with mortality. Similarly, API and PAPi have demonstrated strong predictive power for adverse outcomes, including death and the need for advanced HF therapies. RAP/PCWP ratio is shown to be a valuable a prognostic tool for RV dysfunction, mortality, and adverse outcomes. Despite mixed evidence on the prognostic utility of RVSWI, its physiologic relevance in assessing right ventricular function remains important. A novel clinical observation, involving patients with an RAP numerically greater than pulmonary artery saturation, was associated with a 71% 30-day mortality rate, underscoring the potential prognostic value of this finding. This review aims to summarize key advanced hemodynamic markers and their role in improving risk stratification and guiding treatment in CS and end-stage HF. The integration of these markers into clinical practice holds the potential to enhance personalized care and improve outcomes for patients with CS and advanced HF.

Freeze-dried plasma: Hemostasis and biophysical analyses for damage control resuscitation.

Effective hemorrhage protocols prioritize immediate hemostatic resuscitation to manage hemorrhagic shock. Prehospital resuscitation using blood products, such as whole blood or alternatively dried plasma in its absence, has the potential to improve outcomes in hemorrhagic shock patients. However, integrating blood products into prehospital care poses substantial logistical challenges due to issues with storage, transport, and administration in field environments. We utilized hemostatic assays and advanced biophysical techniques, such as calorimetry, infrared spectoscopy, dynamic light scattering,and biolayer interferometry, to compare the functional and structural properties of freeze-dried plasma (FDP; OctaplasLG Powder, Octapharma AB) with those of fresh plasma controls. Hemostatic characterization of FDP revealed that clot formation properties and coagulation parameters were largely comparable to fresh plasma controls, with some variations observed in Von Willebrand factor-ADAMTS13 axis and fibrinolysis. No change to moisture content of FDP (~1% water content) was observed after 6-month storage at ambient conditions. Biophysical analyses of FDP during transfusion demonstrated spontaneous exothermic mixing of FDP in plasma, a dilution effect from saline, as well as comparable stability to plasma controls. Quantification of ligand-binding affinities of platelet receptors activated GPIIbIIIa and GPIbα showed comparable binding properties to plasma controls. Our results show that FDP exhibits hemostatic functionality and protein stability on par with fresh plasma, as assessed by novel, highly sensitive techniques. FDP therefore represents a viable alternative to conventional plasma in damage control resuscitation, offering significant logistical and storage advantages for prehospital and remote applications, especially in scenarios where whole blood is unavailable.

Early and high-volume administration of sodium bicarbonate in sepsis-associated acute kidney injury in patients with malignancies, during continuous renal replacement therapy

Introduction Sepsis is an uncontrolled systemic response to infection that leads to life-threatening organ dysfunction. The in-hospital mortality rate remains significantly high in septic shock patients with malignancies. This study investigates whether early and high-volume administration of sodium bicarbonate during continuous renal replacement therapy (CRRT) can reduce 28-day mortality, increase shock reversal rates, and shorten the duration of CRRT, mechanical ventilation, and intensive care unit (ICU) stays. The goal is to provide valuable clinical data for the management of cancer patients with sepsis-associated acute kidney injury (SAKI). Materials and methods A retrospective study was performed on 88 patients who were admitted to the ICU and received continuous renal replacement therapy (CRRT) for acute renal failure secondary to sepsis at the Cancer Center of Sun Yat-sen University from March 2010 to October 2021. Based on the initiation time of CRRT and the volume of sodium bicarbonate infusion, patients were divided into four groups: the early high-volume group, early low-volume group, late high-volume group, and late low-volume group. Results The results of this study showed that in the 28-day mortality model, established using the Cox proportional hazards method, early CRRT (HR 0.473; 95% CI 0.245–0.915, p = 0.026) and high-volume sodium bicarbonate infusion (HR 0.173; 95% CI 0.078–0.383, p < 0.001) were identified as two independent protective factors. The 28-day mortality rate in the early high-volume group (15.0%) was significantly lower than that of the other three groups (60.0%, 30.0%, and 75.0%, respectively; χ 2 = 23.822, p < 0.001). Additionally, the shock reversal rate in the early high-volume group (80.0%) was significantly higher compared to the other groups (35.0%, 45.0%, and 35.7%; χ 2 =13.576, p = 0.004). The duration of CRRT was shorter in the early high-volume group (35.0 ± 4.45 h) than in the other groups (70.0 ± 30.19 h, 48.0 ± 5.22 h, and 72.0 ± 19.84 h; χ 2 =11.278, p = 0.01). Furthermore, the duration of mechanical ventilation (7.0 ± 3.33 days) was lower in the early high-volume group compared to the other groups (8.0 ± 1.12 days,10.0 ± 1.11 days, and 8.0 ± 2.65 days; χ 2 =8.064, p = 0.045), as was the length of ICU stay (7.0 ± 0.89 days) compared to the other groups (13.0 ± 3.35 days, 10.0 ± 1.49 days, and10.0 ± 3.70 days; χ 2 = 9.184, p = 0.027). Conclusion Early and high-volume administration of sodium bicarbonate during CRRT may reduce 28-day mortality and improve shock reversal rates in patients with sepsis-associated acute kidney injury complicated by malignancy. Prospective randomized controlled large sample studies are needed to confirm this.

Utilization of Palliative Care in Cardiogenic Shock Patients: A Retrospective Analysis of the National Inpatient Sample Database, 2020.

Background: Cardiogenic shock (CS) is one of the leading causes of death in patients with myocardial infarction, myocarditis, and congestive heart failure. The utilization patterns of specialist palliative care (PC) consultation in these patients are currently unknown. Objectives: To determine the utilization of PC in patients with CS and the overall comorbidities of that population. Methods: Review of the 2020 National Inpatient Sample identified 6,471,165 hospitalizations of which 38,531 patients were hospitalized with CS via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) code R57.0. Demographics and details of hospitalization were compared for patients who received PC evaluation (N = 8457) and those who did not (N = 30,074) as identified via ICD-10 CM code Z51.5. Results: Patients who received PC evaluation were older (≥65 years: 69.01% vs. 55.04%, p < 0.001), had shorter hospital stays (<14 days: 78.92% vs. 70.35% patients, p < 0.001), and higher in-hospital mortality (65.80% vs. 24.23%, p < 0.001) with higher Charlson Comorbidity Index (≥4, 55.22% vs. 48.09%, p < 0.001). Furthermore, the patients who received PC had significantly higher odds of death than those who did not (adjusted odds ratio = 6, p < 0.0001). Conclusion: Despite high mortality rates, specialist PC is not routinely involved in the care of those who die with CS, although does appear to be utilized among those most likely to die. This suggests preferential utilization of specialist PC for terminal patients; however, further research will be helpful to better understand current consult practices and increase PC utilization for this highly morbid population.

Left ventricular diastolic dysfunction is prevalent but not associated with mortality in patients with septic shock.

Prognostic impact of left ventricular diastolic dysfunction (LVDD) in septic shock patients has not been determined using current diagnostic guidelines. We assessed the relation between LVDD during the first 3days following intensive care unit (ICU) admission for septic shock and Day-28 mortality. This prospective, multicenter, observational study enrolled 402 patients (age: 63 ± 13year; 59% male; SAPS II: 59 ± 20; SOFA: 9.4 ± 3.6; mechanical ventilation: 74%) with septic shock (Sepsis-3 definition). Patients were echocardiographically assessed within 12h after admission (Day 1), on Day 2, Day 3, at ICU and at hospital discharge (or Day 28 whichever occurred first), using 2016 American-European guidelines. LVDD was present at least once between Day 1 and 3 in 304 patients (76%), and in 56% and 44% of patients at ICU discharge and on Day 28 (or hospital discharge), respectively (43% of patients with follow-up). Seventy-eight of 172 patients (45%) exhibited similar LV diastolic properties throughout the study period while 58 patients (34%) improved their LVDD at follow-up (lower grade: n = 9, regression: n = 49). Day-28 mortality was not statistically different between patients with and without LVDD (80/304 [26%] vs. 25/88 [28%]; OR: 0.900 [0.530-1.527]; p = 0.696). Similar results were obtained when adjusting the multivariate model on SAPSII or SOFA score on admission, together with fluid balance during the first three days of ICU stay (OR: 0.838 [0.471-1.491]: p = 0.547 and OR: 0.887 [0.513-1.534]: p = 0.668, respectively). LVDD was highly prevalent in patients with septic shock but not associated with mortality. It appeared improving in one-third of survivors. PRODIASYS study registered on ClinicalTrials (September 27, 2016, number NCT02918214).

Prediction of Acute Kidney Injury for Critically Ill Cardiogenic Shock Patients with Machine Learning Algorithms.

The aim of this study was to use five machine learning approaches and logistic regression to design and validate the acute kidney injury (AKI) prediction model for critically ill individuals with cardiogenic shock (CS). All patients who diagnosed with CS from the MIMIC-IV database, the eICU database, and Zhongnan hospital of Wuhan university were included in this study. Clinical information, including demographics, comorbidities, vital signs, critical illness scores and laboratory tests was retrospectively collected. Five machine learning algorithms (LightGBM, decision tree, XGBoost, random forest, and ensemble model) and one conventional logistic regression were applied for the prediction of AKI in critically ill individuals with CS. ROC curves were generated via python software to assess the overall performance of machine learning algorithms and the SHAP analysis was adopted to reveal the impact of prediction for each feature. The ensemble model exhibited the best predictive ability (AUC:0.91, 95% CI, 0.88-0.94), followed by random forest (AUC:0.90, 95% CI, 0.86-0.94) and XGBoost (AUC:0.89, 95% CI, 0.84-0.92). While the logistic regression model obtained the worst predictive performance (AUC:0.62, 95% CI, 0.56-0.68). When validated the prediction models with eICU database, the ensemble model exhibited the best predictive ability (AUC:0.92, 95% CI, 0.89-0.96), while the logistic model obtained the worst predictive performance (AUC:0.61, 95% CI, 0.56-0.67). Finally, we verified the prediction models using the data from our hospital and ensemble model still exhibited the best predictive ability (AUC:0.74, 95% CI, 0.62-0.86), while the decision tree model obtained the worst predictive performance (AUC:0.52, 95% CI 0.35-0.70). Machine learning algorithms could be utilized for the AKI prediction among critically ill CS patients, and exhibit superior predictive performance compared to the conventional logistic regression analysis.

Hyperglycemia Risk Evaluation of Hydrocortisone Intermittent Boluses Vs Continuous Infusion in Diabetic Patients with Septic Shock: A Prospective Cohort Study

Background &amp; Objectives: Septic shock is a serious condition associated with a high mortality rate because of the multiorgan dysfunction caused by dysregulated host immune responses to infection. Giving low dose steroids in septic shock patients has been shown to hasten the reversal of shock and current Surviving Sepsis Guidelines (SSG) also suggest using low dose steroids for the same. Also, the use of steroids causes hyperglycaemia particularly in diabetic patients. The current SSG does not specify the method of administration. The primary objective of our study was to compare continuous infusion vs intermittent boluses of hydrocortisone to obtain a better glycaemic control. Methods: A prospective cohort study was conducted in diabetic patients with septic shock admitted in Multi Disciplinary Intensive Care Unit (MDICU) of PRS hospital from July 2022 to February2023. Hydrocortisone was given as continuous infusion in 55 subjects and the remaining 55 received intermittent boluses of hydrocortisone and average blood glucose values were measured in both the groups. Results: Among 110 patients, 55 patients each received continuous infusion and intermittent boluses of hydrocortisone respectively. The mean blood glucose values in continuous infusion group were 161.1 ± 22.7 and 172.5 ± 21.0 (mg/ dl) in intermittent boluses group which was statistically significant with a p value of 0.007. There was no statistically significant difference among the groups in 28-day mortality, ICU length of stay (LOS), hospital LOS, or other secondary safety outcomes. Conclusions: This study infers that giving hydrocortisone as continuous infusions in septic shock patients leads to better glycaemic control when compared to intermittent boluses of hydrocortisone, without any difference in 28-day mortality.

Clinical outcomes following shock team implementation for cardiogenic shock: a systematic review

Abstract Background Cardiogenic shock is a critical cardiac condition characterized by low cardiac output leading to end-organ hypoperfusion and associated with high in-hospital mortality rates. It can manifest following acute myocardial infarction or acute exacerbation of chronic heart failure. Despite advancements, mortality rates remain elevated, prompting interest in multidisciplinary approaches to improve outcomes. This manuscript presents a review focused on the concept of a cardiogenic shock team and its potential impact on patient management and outcomes. Methods A comprehensive search was performed on March 19, 2023, covering PubMed, Web of Science, Scopus, Embase, and Cochrane Library. We included primary studies (prospective and retrospective) only and evaluated their quality using the Newcastle–Ottawa Quality Scale. This review was registered in PROSPERO (CRD42023440354). Results Six relevant studies with 2066 cardiogenic shock patients were included, of which 1071 were managed by shock teams and 995 received standard care. Findings from the reviewed studies indicated the favorable outcomes associated with implementing cardiogenic shock teams. Patients managed by these teams exhibited higher 30-day and in-hospital survival rates compared to those without team intervention. The implementation of cardiogenic shock teams was linked to reduced in-hospital and intensive care unit mortality rates. Additionally, shock team involvement was associated with shorter door-to-balloon times. Conclusion The findings suggest that cardiogenic shock teams play a crucial role in improving patient outcomes through earlier detection and timely interventions. Despite challenges in team implementation, their potential to reduce mortality and improve efficiency in patient care warrants further research and greater integration of multidisciplinary strategies into clinical practice.

Efficacy and safety of Chinese tonic medicines for treating sepsis or septic shock: a protocol for a systematic review and Bayesian network meta-analysis of randomized controlled trials

BackgroundSepsis is a life-threatening organ dysfunction with high morbidity and mortality. Various studies have demonstrated the effectiveness of Chinese tonic medicines (CTMs) in treating sepsis or septic shock. However, trials directly comparing the efficacy and safety of different CTMs for sepsis or septic shock are still lacking. To identify the most optimal CTM for treating sepsis or septic shock, we plan to perform a systematic review and network meta-analysis of various CTMs used for sepsis or septic shock patients.MethodsRandomized controlled trials (RCTs) that investigated the efficacy and safety of CTMs for patients with sepsis or septic shock will be systematically searched in Pubmed, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web Of Science, CBM, CNKI, Wanfang, and VIP databases from inception to November 2023. The quality of the included studies will be assessed using the Cochrane Risk of Bias V.2.0. tool. The confidence of evidence will be evaluated through the CINeMA (Confidence in Network Meta-Analysis) web application. Primary outcomes include the delta Sequential Organ Failure Assessment (△SOFA) score at day 7 after interventions and 28-day mortality. Secondary outcomes comprise delta serum lactate levels (△Lac) and delta mean arterial pressure (△MAP) at day 7 after interventions as well as total dose and duration of vasoactive drugs. Safety outcome includes adverse drug reactions or adverse drug events (ADRs/ADEs). The Bayesian network meta-analysis will be conducted using the “BUGSnet” package in R version 4.2.2. The surface under the cumulative ranking curve (SUCRA) values will be used to rank each treatment. Statistical inconsistency assessment, publication bias assessment, heterogeneity analysis, sensitivity analysis, and subgroup analysis will be performed.DiscussionThis study will provide new insights into the efficacy and safety of various CTMs used in sepsis or septic shock patients, providing help for future clinical practice and research.Systematic review registrationCRD42023482572

Impact of 30 mL/kg fluid resuscitation completed within one hour on elderly septic shock patient

Objective This study aimed to investigate the prognostic impact of completing 30 mL/kg fluid resuscitation within 1 h in elderly septic shock patients. Methods This was a multicenter prospective observational cohort study. We applied logistic regression to assess the impact of completing 30 mL/kg fluid resuscitation within 1 h on respiratory support escalation including new-onset mechanical ventilation, bilevel positive airway pressure (BiPAP), and high-flow nasal cannula (HFNC) as well as heart failure (HF). We plotted Kaplan-Meier (K-M) curves to evaluate survival in patients completing 30 mL/kg fluid resuscitation within 1 h. We performed mediation analyses to determine the influence of HF on mortality associated with completing 30 mL/kg fluid resuscitation within 1 h. Results Completing 30 mL/kg fluid resuscitation within 1 h increased the odds ratios of new-onset BiPAP (adjusted OR = 3.411; 95% confidence interval (CI) = [1.526, 7.620]) and HFNC (adjusted OR = 2.576; 95% CI = [1.252, 5.297]) within 24 h as well as the odds ratio of HF (adjusted OR = 2.291; 95% CI = [1.266, 4.149]). The adjusted K-M curve showed that patients completing 30 mL/kg fluid resuscitation within 1 h had higher 30-d mortality than those completing it over longer periods. The mediation effect suggested that completing 30 mL/kg fluid resuscitation within 1 h could be fatal primarily because it increased the risk of HF. Conclusion For elderly patients with septic shock, completing 30 ml/kg of fluid resuscitation within 1 h ought to be more cautious, particularly considering the patient’s cardiac function and overall clinical status.

Extension of an ICU-based noninvasive model to predict latent shock in the emergency department: an exploratory study

BackgroundArtificial intelligence (AI) has been widely adopted for the prediction of latent shock occurrence in critically ill patients in intensive care units (ICUs). However, the usefulness of an ICU-based model to predict latent shock risk in an emergency department (ED) setting remains unclear. This study aimed to develop an AI model to predict latent shock risk in patients admitted to EDs.MethodsMultiple regression analysis was used to compare the difference between Medical Information Mart for Intensive Care (MIMIC)-IV-ICU and MIMIC-IV-ED datasets. An adult noninvasive model was constructed based on the MIMIC-IV-ICU v3.0 database and was externally validated in populations admitted to an ED. Its efficiency was compared with efficiency of testing with noninvasive systolic blood pressure (nSBP) and shock index.ResultsA total of 50,636 patients from the MIMIC-IV-ICU database was used to develop the model, and a total of 2,142 patients from the Philips IntelliSpace Critical Care and Anesthesia (ICCA)-ED and 425,087 patients from the MIMIC-IV-ED were used for external validation. The modeling and validation data revealed similar non-invasive feature distributions. Multiple regression analysis of the MIMIC-IV-ICU and MIMIC-IV-ED datasets showed mostly similar characteristics. The area under the receiver operating characteristic curve (AUROC) of the noninvasive model 10 min before the intervention was 0.90 (95% CI: 0.84–0.96), and the diagnosis accordance rate (DAR) was above 80%. More than 80% of latent shock patients were identified more than 70 min earlier using the noninvasive model; thus, it performed better than evaluating shock index and nSBP.ConclusionThe adult noninvasive model can effectively predict latent shock occurrence in EDs, which is better than using shock index and nSBP.

The nadir platelet count in the first 48 h after ICU admission is a potential predictor of acute kidney injury in hemorrhagic shock patients

BackgroundThe relationship between the nadir platelet count within the first 48 h after intensive care unit (ICU) admission and the occurrence of acute kidney injury (AKI) in hemorrhagic shock patients remains unclear. This study investigated this association in adult patients admitted to the surgical ICU for hemorrhagic shock.MethodsWe included 124 hemorrhagic shock patients, excluding those with pre-existing AKI or chronic kidney disease (CKD), admitted to two affiliated hospitals between January 2019 and May 2022. The nadir platelet count was defined as the lowest value within the first 48 h after ICU admission. AKI was diagnosed based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. We used multivariate logistic regression to identify independent risk factors for AKI and analyzed the area under the receiver operating characteristic curve (AUC) for diagnostic accuracy.ResultsPatients with AKI (n = 72) had significantly lower nadir platelet counts compared to those without AKI. The nadir platelet count was identified as an independent risk factor for AKI (OR = 0.988, 95% CI: 0.978–0.999, P = 0.035). The AUC for predicting AKI was 0.862 (95% CI: 0.795–0.929). Combining the nadir platelet count with serum cystatin C levels enhanced the predictive accuracy (AUC = 0.922, 95% CI: 0.870–0.973, P < 0.001).ConclusionsThe nadir platelet count in the first 48 h after ICU admission is independently associated with the risk of AKI in hemorrhagic shock patients and could serve as a potential predictor when combined with serum cystatin C levels.

Left Ventricular Unloading With Surgically Implanted Microaxial Flow Pump in Patients on Venoarterial Membrane Oxygenation.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is applied for the treatment of cardiogenic shock. Concomitant left ventricular unloading (LVU) with a microaxial flow pump (mAFP) enables myocardial and pulmonary recovery and may overcome some of the limitations of VA-ECMO. The study included 145 cardiogenic shock patients, 89 (61.4%) of whom were treated with VA-ECMO alone (ECMO group), whereas 56 (38.6%) received LVU with a surgically implanted mAFP on top of VA-ECMO (ECMELLA group). After 2:1 propensity score matching, 30 day and 1 year survival was similar between the groups (p = 0.62 and 0.68, respectively). In the subgroup analysis, patients who received mAFP in the first 2 hours after VA-ECMO implantation had an improved 30 day (hazard ratio [HR]: 0.45 [95% confidence interval {CI}: 0.23-0.88], p = 0.02) and 1 year survival (HR: 0.52 [95% CI: 0.28-0.97], p = 0.04). The rate of limb ischemia, hemorrhage, and renal replacement therapy were comparable between the propensity score-matched cohorts. Early LVU with a surgically implanted mAFP in patients on VA-ECMO improved short-and long-term survival.

Vasoactive Agents in Burn Patients - Perspectives on Angiotensin-II.

Severe burn injury poses significant clinical challenges, often necessitating the use of vasoactive agents to maintain perfusion. This narrative review explores the current landscape of vasoactive agents in acute burn shock resuscitation and severe burn-injured patients who develop septic shock, with a particular focus on the potential role of the novel vasoactive agent, synthetic angiotensin-II (AT-II), in these settings. While catecholamines and vasopressin remain cornerstone therapies, adverse effects, variable patient response, and a new understanding of burn injury pathophysiology highlight the potentially evolving role of vasoactive agents in these clinical scenarios. A key system involved in blood pressure regulation, the renin-angiotensin-aldosterone system (RAAS), is often dysregulated in acute burn and septic shock. Contributory mechanisms and potential benefits of synthetic AT-II are discussed here within and form the physiologic rationale behind exogenous administration of synthetic AT-II in the context of available safety and efficacy data. To date, administration of synthetic AT-II administration has shown promise in improving hemodynamics and clinical outcomes in distributive shock populations; however, data in acute burn shock and burn patients who develop septic shock are lacking. In addition, a comprehensive understanding of the potential and future areas of research in burn shock and severe burn-injured patients is provided.

Does Continuous Renal Replacement Therapy with oXiris in Septic Shock Have Any Positive Impact? Single-Centre Experience with oXiris Therapy in Septic Shock Patients

Background: Renal replacement therapy with an oXiris hemofilter may be helpful for patients with acute kidney injury in conjunction with sepsis and septic shock. The aim of this study was to assess the impact of an oXiris membrane on septic shock patients. Methods: All renal replacement therapies with oXiris (Baxter, Deerfield, IL, USA) performed between January 2018 and August 2021 were retrospectively analyzed. CRRT was initiated in continuous venovenous hemodiafiltration (CVVHDF) mode using Prismaflex System (Baxter). Demographic data, starting point of infection, source control, etiology, and course of treatment were analyzed. Results: A total of 32 patients were included in the study. Most patients treated with oXiris had acute kidney injury (AKI) and required CRRT. One patient had KDIGO 1 AKI (3.1%), three patients (9.4%) had KDIGO 2 AKI, and 28 patients (87.5%) had KDIGO 3 AKI. A statistically significant decrease in vasopressin dosage was required to achieve adequate MAP after 24 and 72 h, and a statistically significant decrease in norepinephrine dosage after 72 h was observed, with no SOFA score change on days 2 and 3. Procalcitonin and lactate levels did not change after 24 and 72 h. No beneficial effect on mortality was observed. Conclusions: Treatment with an oXiris membrane can positively impact vasopressors’ requirement but not influence SOFA score, procalcitonin or lactate levels, or mortality in septic shock patients.

Identification of cuproptosis-related genes in septic shock based on bioinformatic analysis.

Septic shock is a life-threatening condition characterized by a failure of organ systems and a high mortality rate. Cuproptosis is a new form of cell death that is triggered by copper overload. However, the relationship between cuproptosis-related genes and septic shock remains unclear. The GSE26440 dataset from the GEO database was used to screen differentially expressed genes (DEGs) between control and septic shock samples. Additionally, hub genes related to the progression of septic shock and cuproptosis were screened by Venn analysis. RT-qPCR was utilized to validate the expression of hub genes in peripheral blood lymphocytes from septic shock patients and healthy controls. Next, functional analysis and immune cells infiltration were performed. SLC31A1 and MTF1 levels were obviously elevated and LIAS and LIPT1 levels were downregulated in septic shock samples, compared to normal controls. The diagnostic values of the four genes were confirmed with receiver operating characteristic (ROC) curves. Additionally, SLC31A1 and MTF1 showed a positive correlation with natural killer cells and LIAS and LIPT1 exhibited a positive correlation with CD8+ T cells. Furthermore, compared to low-level groups, MAPK signaling was activated in the high-SLC31A1 level group, VEGF signaling was activated in the high-MTF1 level group and lipoic acid metabolism was activated in high-LIAS and high-LIPT1 level groups. This study demonstrates that SLC31A1, MTF1, LIAS, and LIPT1 are dysregulated in septic shock samples, and these genes exhibit potential diagnostic efficacy in septic shock, suggesting that these genes may be potential biomarkers for the diagnosis of septic shock.

Shock Patients and Enteral Nutrition?

Shock is a life-threatening condition characterized by microcirculatory disturbances and inadequate tissue perfusion. In hemodynamically unstable individuals, arterial pressure is maintained with vasoactive agents. Enteral nutrition (EN) is crucial for the intensive treatment of critically ill patients, facilitating intestinal recovery and improving clinical outcomes such as reducing infections, shortening hospital stays, and lowering costs. The impact of vasoactive agents on gastrointestinal blood flow varies, depending on the drug, dose, body size, and individual sensitivity. EN is categorized into early and delayed, and multiple guidelines recommend delayed EN due to the risks in the early stage, which may lead to EFI, non-obstructive mesenteric ischemia and necrosis. Guidelines for early EN in shock patients are still evolving, exploring the optimal timing and safety thresholds. Studies have shown that early EN can be safely implemented in hemodynamically stable patients maintaining a mean arterial pressure of 70 mmHg with stable doses of antihypertensives. This review summarizes the optimal and safe timing of initiating EN in shock patients to guide clinical practice. The pathophysiology of shock, EN selection, considerations, nutritional regimens, effects of antihypertensive agents, and feeding regimens are further discussed.

Comparison of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment intensive care unit scoring system as mortality predictors in intensive care unit patients with sepsis

Background: Sepsis is a life-threatening organ dysfunction caused by a deregulated host response to infection. It is one of the leading causes of in-hospital mortality and morbidity among patients. It also results in significant morbidity and financial burden. Aims and Objectives: (1) To study the etiological profile of patients admitting with sepsis to ICU. (2) To compare between APACHE II and SOFA ICU scoring system of patients with sepsis at admission and at 24 h in predicting the 5th-day mortality. Materials and Methods: This was a single center hospital based prospective, observational, study conducted in patients in ICUs of ESICMC PGIMSR and Model Hospital Rajajinagar, Bangalore. Patients over age 18 years admitted in ICU who have fulfilled the criteria for sepsis were included in our study. Their clinical profile, APACHE II and SOFA scores were evaluated and followed up to 5th day of admission and data were compared with respect to patients’ outcome in the form of survival. Results: In this study, out of 53 patients the maximum number of patients belong to the age groups of &gt;60 years (23 patients). Male-to-female distribution in this study noted was 30 and 23 patients, respectively. Aspiration Pneumonitis (17%) and Community-Acquired Pneumonia (17%) were the most common causes of septic. Out of 53 patients, 31 patients did not survive. In this study, it was observed that the SOFA scoring had the highest specificity (87.10%) and APACHE II had the highest sensitivity (96.77%) at admission. However at 24 h of admission, both the highest sensitivity and highest specificity was more for APACHE II score. The most area under the Receiver-operating characteristic curve was better for SOFA score (AUROC=58.0%) at admission than APACHE II score with AUROC of 53.7%, however AUROC of both SOFA and APACHE II score calculated at 24 h of admission were equally good in predicting 5th-day mortality. Conclusion: We found that the SOFA score outperformed APACHE II scores in predicting survival in septic shock patients at admission. SOFA and APACHE II calculated at 24 h of admission and both scores provided equal efficacy in predicting 5th-day mortality in patients with sepsis.

Comparison of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment intensive care unit scoring system as mortality predictors in intensive care unit patients with sepsis

Background: Sepsis is a life-threatening organ dysfunction caused by a deregulated host response to infection. It is one of the leading causes of in-hospital mortality and morbidity among patients. It also results in significant morbidity and financial burden. Aims and Objectives: (1) To study the etiological profile of patients admitting with sepsis to ICU. (2) To compare between APACHE II and SOFA ICU scoring system of patients with sepsis at admission and at 24 h in predicting the 5th-day mortality. Materials and Methods: This was a single center hospital based prospective, observational, study conducted in patients in ICUs of ESICMC PGIMSR and Model Hospital Rajajinagar, Bangalore. Patients over age 18 years admitted in ICU who have fulfilled the criteria for sepsis were included in our study. Their clinical profile, APACHE II and SOFA scores were evaluated and followed up to 5th day of admission and data were compared with respect to patients’ outcome in the form of survival. Results: In this study, out of 53 patients the maximum number of patients belong to the age groups of &gt;60 years (23 patients). Male-to-female distribution in this study noted was 30 and 23 patients, respectively. Aspiration Pneumonitis (17%) and Community-Acquired Pneumonia (17%) were the most common causes of septic. Out of 53 patients, 31 patients did not survive. In this study, it was observed that the SOFA scoring had the highest specificity (87.10%) and APACHE II had the highest sensitivity (96.77%) at admission. However at 24 h of admission, both the highest sensitivity and highest specificity was more for APACHE II score. The most area under the Receiver-operating characteristic curve was better for SOFA score (AUROC=58.0%) at admission than APACHE II score with AUROC of 53.7%, however AUROC of both SOFA and APACHE II score calculated at 24 h of admission were equally good in predicting 5th-day mortality. Conclusion: We found that the SOFA score outperformed APACHE II scores in predicting survival in septic shock patients at admission. SOFA and APACHE II calculated at 24 h of admission and both scores provided equal efficacy in predicting 5th-day mortality in patients with sepsis.