Shock In ICU Research Articles

Neurogenic Shock in ICU

Neurogenic Shock in ICU

Retracted: Care Bundles plus Detailed Nursing on Mortality and Nursing Satisfaction of Patients with Septic Shock in ICU.

[This retracts the article DOI: 10.1155/2022/1177961.].

Integrated transcriptomic and regulatory network analyses uncovers the role of let-7b-5p, SPIB, and HLA-DPB1 in sepsis

Sepsis has affected millions of populations of all age groups, locations, and sexes worldwide. Immune systems, either innate or adaptive are dysregulated due to the infection. Various biomarkers are present to date, still sepsis is a primary cause of mortality. Globally, post-operative body infections can cause sepsis and septic shock in ICU. Abnormal antigen presentation to T-cells leads to a dysregulated immune system. miRNAs are sparkly evolved as biomarkers due to their high sensitivity and efficiency. In this work, we analyzed high-throughput mRNA data collected from Gene Expression Omnibus (GEO) and linked it to significant miRNAs and TFs using a network-based approach. Protein–protein interaction (PPI) network was constructed using sepsis-specific differentially expressed genes (DEGs) followed by enrichment analyses and hub module detection. Sepsis-linked decrease transcription of the classical HLA gene such as HLA-DPB1 and its interplay with miR-let-7b-5p and transcription factor SPIB was observed. This study helped to provide innovative targets for sepsis.

Effect of hydrocortisone on outcome of septic shock patients. A prospective observational study in a tertiary care ICU.

Introduction: Sepsis and septic shock have 10% and 40% mortality in ICU respectively. Early recognition and prompt management of septic shock in ICU can reduce mortality. Further, some studies have suggested that hydrocortisone can impact outcome of septic shock significantly. Methodology: We designed prospective observational study to evaluate the effect of hydrocortisone in septic shock patients. Septic shock was defined according to definition proposed by international consensus definition of septic shock 2016. We excluded those who were less than 18 years and receiving steroids for some other indication at the time of admission to ICU. Primary outcome was to determine mortality in ICU. Secondary outcome was to evaluate length of stay, vasopressor days, vasopressor free days and dose of norepinephrine. Results: We studied 208 cases of septic shock. Median age was 61 years. Out of 208 participants, 106 received hydrocortisone. Out of 102 cases who did not receive hydrocortisone, 56.7% died and 42.3% survived (p=<0.001). There was no effect of hydrocortisone on length of stay, vasopressor days, vasopressor free days (OR: 0.7,0.3,1.1), (p=0.98,0.92,0.93) respectively. Conclusion: We concluded that hydrocortisone reduces mortality in septic shock patients in ICU. Keywords: Sepsis, hypotension, hypovolemia, septic shock

Relationship between Dynamic Changes of Microcirculation Flow, Tissue Perfusion Parameters, and Lactate Level and Mortality of Septic Shock in ICU.

Background Septic shock is a common clinical critical disease with high mortality, hemodynamic instability, and easy to be complicated with multiple organ failure. The rapid progress of the patient's condition poses a serious threat to patient's safety. Aim To investigate the relationship between the dynamic monitoring of microcirculation perfusion parameters and blood lactic acid level and the prognosis of patients with infection shock in ICU. Methods A total of 104 patients with septic shock admitted to ICU of Affiliated Hai'an Hospital of Nantong University from February 2018 to June 2021 were selected for clinical research. According to the survival situation of patients after 28 days of treatment, they were divided into the death group (n = 48) and the survival group (n = 56). The central venous-arterial carbon dioxide partial pressure difference (Pcv-aCO2), the ratio of central venous-arterial carbon dioxide partial pressure difference to arterial central venous oxygen content difference (Pcv-aCO2/Ca-cvO2), and blood lactic acid level were retrospectively analyzed and compared between the two groups on the first, third, and seventh days after admission to ICU. The odds ratio (OR) of three indexes affecting the prognosis of patients with septic shock was analyzed by univariate and multivariate mathematical models, and the value of three indexes in predicting the prognosis of patients was analyzed by receiver operating curve (ROC). Results Pcv-aCO2 and lactic acid in the death group were higher than those in the survival group on the 1st, 3rd, and 7th day of ICU stay (P < 0.05). The Pcv-aCO2/Ca-cvO2 of the death group was higher than that of the survival group on the 3rd and 7th day of ICU stay (P < 0.05). Logistic model results showed that age, SOFA score, APACHE II score, the number of multiple organ failure (MODS), intracranial infection, the increase of Pcv-aCO2, Pcv-aCO2/Ca-cvO2, and the increase of lactic acid were independent risk factors for death in patients with septic shock (OR values were 1.519, 1.808, 1.781, 1.912, 2.069, 1.848, 1.781, and 1.642, respectively, P < 0.05). The results showed that the AUC value of Pcv-aCO2 in predicting death was 0.943, and the sensitivity and specificity were 93.72% and 83.09%, respectively. The AUC value of Pcv-aCO2/Ca-cvO2 for predicting death was 0.887, and the sensitivity and specificity were 81.63% and 77.56%, respectively. The AUC value of lactic acid in predicting death of patients was 0.825, and the sensitivity and specificity were 71.66% and 82.09%, respectively. Conclusion Changes of microcirculation flow tissue perfusion parameters and blood lactic acid level changes are closely related to the prognosis of patients with septic shock, which is of great value in the evaluation of the prognosis of patients with septic shock.

THE USE OF 5% IV ALBUMIN IN PATIENTS WITH SHOCK: DOES IT DECREASE VASOPRESSOR REQUIREMENT?

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Circulatory shock often requires large volume fluid resuscitation as a part of treatment. While crystalloid fluids are more commonly used, many patients in intensive care are unable to receive crystalloid fluids due to conditions such as congestive heart failure and end stage renal disease. Utilizing traditional fluids in such patients often complicates hospital courses. There are many studies regarding the benefits, effects and potential harms of using IV albumin for fluid resuscitation. The 2004 SAFE study suggested some benefit of using IV albumin in sepsis but equivocal to conventional management in morbidity and mortality. The 2014 ALBIOS Study of IV albumin use resulted in 90 day mortality benefit and decreased vasopressor need in severely septic patients. Despite these studies, the use of IV albumin in the critically ill remains controversial with consensus or guidelines being established regarding its use. METHODS: We conducted a retrospective study of 70 critically ill patients admitted to MICU from 7/2019 to 5/2020 to assess the effects of IV albumin. Patients diagnosed with shock who received 5% IV albumin were included. Patients who received 25% IV albumin were excluded. We analyzed cases by type of shock, conditions limiting crystalloid bolus, serum albumin level before IV albumin, MAP pre- and post- albumin infusion, pressor requirement (type/duration), development of ARDS, HD/CRRT requirement, COVID status and mortality. RESULTS: Septic shock patients received IV albumin most, followed by cardiogenic shock. Those unable to receive fluid boluses were due to primarily cardiac etiology, followed by renal & hepatic. Increased MAP was observed after IV albumin infusion in many cases. Serum albumin 2.8 on ICU admission responded better to IV albumin and had lower vasopressor requirements.IV albumin was not related with renal dysfunction and those receiving IV Albumin did not need HD/CRRT. 69.6% did not develop ARDS, 5.8% developed ARDS, 24.6% tested positive for COVID and they were excluded from the ARDS incidence rate. Survival rate was 65.7%, mortality rate 24.3% and 10% went to hospice CONCLUSIONS: The use of 5% IV albumin for volume resuscitation in patients with different forms of shock in ICU showed favorable results, especially in those with serum albumin >2.7-2.8. Our retrospective study showed low incidence of adverse events such as cardiogenic pulmonary edema, ARDS or a need for HD/CRRT, lower vasopressor requirement, in both duration and agents used. Further research should be done in this regard to solidify these findings and to establish clear guidelines/protocols regarding the use of albumin as a resuscitative fluid in the ICU setting. CLINICAL IMPLICATIONS: When treating patients with shock and specially patients with hypoalbuminemia, 5% IV albumin can potentially be used as a means to decrease vasopressor requirements and duration without increasing the risk of pulmonary edema, ARDS and renal dysfunction. Further research should be done in this regard to solidify these findings and to establish clear guidelines/protocols regarding the use of albumin as a resuscitative fluid in the ICU setting. DISCLOSURES: No relevant relationships by Andrew Ajemian, source=Web Response No relevant relationships by Muhammad Umer Altaf, source=Web Response No relevant relationships by Christopher Bowman, source=Web Response No relevant relationships by Gabriel Diaz, source=Web Response No relevant relationships by Jessica Obeahon, source=Web Response No relevant relationships by Travis Yamanaka, source=Web Response

Comparison of Mortality Prediction, of APACHE II, SAPS II and SOFA ICU Scoring Systems in Patients with Severe Sepsis and Septic Shock in ICU of A Tertiary Care Hospital

Comparison of Mortality Prediction, of APACHE II, SAPS II and SOFA ICU Scoring Systems in Patients with Severe Sepsis and Septic Shock in ICU of A Tertiary Care Hospital

Dynamic left intraventricular obstruction in patients with septic shock: pathogenetic role and prognostic implications

Background Left intraventricular flow obstruction (IVO) has been classically described in asymmetric hypertrophic cardiomyopathy, usually at the level of the left ventricular outflow tract (LVOT) or at midcavitary level, which is due to systolic anterior movement of the anterior leaflet of the mitral valve. This phenomenon has also been previously described in certain clinical situations mainly revolving around hypovolemia and catecholamine exposure and recently as a frequent event in patients with septic shock with an important correlation with fluid responsiveness. Multiple studies have demonstrated that static parameters limited the predictive value for fluid responsiveness, whereas dynamic parameters have shown a greater clinical use, including respiratory changes in aortic blood velocity, superior vena cava collapsibility, inferior vena cava (IVC) collapsibility, and changes in stroke volume and Cardiac Output (CO) owing to passive leg raising. Objective This study aimed to assess (a) the prevalence of dynamic IVO in patients with septic shock; (b) relation among IVO, volume status, and fluid responsiveness; and (c) relation between IVO and in-hospital mortality. Patients and methods A total of 40 patients with septic shock were studied over a period of 1 year for the presence of Doppler signs of dynamic IVO, clinical characteristics, hemodynamic parameters, and APACHE II and SOFA scoring. Echocardiographic data including IVC collapsibility, CO, LVOT mean and peak pressure gradient, LVOT maximum velocity, and midcavitary Doppler pattern were recorded initially and following fluid resuscitation (30 ml/kg). Patients were categorized into two groups: group A included patients with IVO and group B included patients without IVO. There was a statistically nonsignificant difference between both groups regarding the baseline demographic, clinical, and hemodynamic parameters. Results A total of 40 (45% were males and 55% females) patients, with a mean age of 52±20 years, were studied, of whom a total of 13 (32%) had IVO versus 27 patients without IVO. Following fluid infusion, as compared with group B, group A showed significantly greater increase in Cardiac Output (COP) (5.85±1.4 vs. 4.4±1.8, P=0.0203) and IVC collapsibility (54.42±6.8 vs 50.56±13, P=0.42). ICU mortality was significantly higher in patients with IVO [10/13 (76.9%)] versus patients without IVO [7/27 (25.9%), P Conclusion Dynamic left IVO is not uncommon in patients with septic shock in ICU. Response to fluid infusion was significantly higher in patients with IVO compared with patients without IVO, pointing to an additional role of fluid resuscitation in patients with sepsis.

Predictive Model for Length of Stay in Intensive Care Unit Based on Preoperative and Perioperative Variables. Four-Year Analysis of Mitral Valve Surgery in One Single Center

Study objective: Assessing length of stay in Intensive Care Units (LOSI) after mitral valve surgery is challenging due to wide spectrum of comorbidities and cardiovascular procedures. The study aim was to elaborate a predictive model in order to identify risk factors and predict the expected resources consumption for better monitoring for caregivers and patients. Design: Retrospective study of prospectively collected data during 2009 and 2013. Setting: University teaching hospital. Patients: We studied all consecutive adult patients (≥ 18 years) who underwent elective mitral valve surgery. We enrolled 212 patients. Measurements: Our outcome variable LOSI. Comorbidities, postoperative morbidity and mortality were collected during the perioperative period. Multivariate analysis was used and data was studied as an additive model to assess the associations between the variables and the presence of correlations between them. Generalized additive model was fitted with least squared means estimated by the additive model due the non linearity of Euroscore I. Histograms of the residuals were examined visually to assess the fit of the models above. The model was selected using the statistical software R version 3.0.2 (R Foundation, Vienna, Austria). Results: Median of LOSI was 4 days (Interquantile range 2 to 4 days). The model for LOSI includes: infection post surgery (p<0.05), cardiogenic shock (p<0.05), Euroscore I (p<0.05), valvular replacement (p<0.05), double valvular disease (p<0.05) and associated tricuspid valve repair (p<0.05). The adjusted r squared for this model was 0.74, which implies a high predictive value for LOSI. In this model the ponderate weights for the main variables were 36.3% for infection post surgery, 15.2% for aortic clamp time, 6.9% for cardiogenic shock and 5.4% for the Euroscore I. Conclusion: Longer LOSI is strongly affected by post surgery infection and cardiogenic shock in ICU, Euroscore I and mitral and tricuspid replacement. Preemptive measures and early treatment of those complications should be a priority in ICU in order to improve outcomes and quality of care in this population

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Learning Objectives: Alcohol related admissions to critical care are increasing. However, the impact of alcohol on the ICU journey has not been extensively studied. Further, there is limited evidence regarding the impact on long terms outcomes for patients admitted to critical care with a background of alcohol misuse. This study aimed to explore the impact of alcohol use disorders on the ICU stay and on longer term outcomes. Methods: 18 month prospective observational cohort study in a 20 bedded mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk; harmful/hazardous or alcohol dependency. Results: 580 ICU patients were screened for the presence of alcohol use disorders during the study period. 34.4% of patients were admitted with a background of alcohol misuse. Those with an alcohol related admission (either the harmful/hazardous or alcohol dependent) had an almost two fold increased odds of developing septic shock during their ICU admission, compared with the low risk group (OR 1.67; 95% CI 1.13-2.47, p=0.01). When adjusted for the presence of liver cirrhosis, the odds of developing septic shock increased even further in those with an alcohol related admission (OR 1.81; 95% CI 1.19-2.76, p=0.005). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p=0.01) and hospital mortality (OR 2.43; 95% CI 1.28-4.621, p=0.004). After adjustment for the presence of septic shock during the ICU admission, age and APACHE II, alcohol dependence was independently associated with mortality at six months post ICU discharge (HR 1.50; 95% CI 1.02-2.22, p= 0.0387). Conclusions: Alcohol related admissions account for a significant proportion of admissions to critical care. Alcohol use disorders are a significant risk factor for the development of septic shock in ICU. Further, alcohol dependency is independently associated with ICU, hospital and 6 month outcomes.

Cinical observation on early fluid resuscitation in treatment of septic shock

Objective To evaluate the effect of early fluid resuscitation in treatment of septic shock.Methods 56 patients with septic shock in ICU were divided into two groups by the method of the treatment. Early goal-directed therapy were given in the early fluid resuscitation group except anti-infective treatment, and the traditional therapy were given in the traditional group. The CVP,MAP,ScvO2 ,SaO2 of 6h and 12h of intra-treatment were observed in the two groups, and the incidence of MODS and the mortality rate were observed also. Results The CVP,MAP, ScvO2, SaO2 of the early fluid resuscitation group were improved better than that in the traditional group. The incidence of MODS and the mortality rate in the early fluid resuscitation group were lower than that in the traditional group. Conclusion The prognosis of septic shock was better for the early fluid resuscitation, and it could lower the incidence of MODS and the mortality rate. Key words: Shock; Fluid Therapy

Vasoactive drugs for vasodilatory shock in ICU

Vasoactive drugs are the mainstay of hemodynamic management of vasodilatory shock when fluids fail to restore adequate tissue perfusion. In this review, studies published during the past year that increase our understanding of the use of vasoactive drugs in the ICU are discussed. The Vasopressin and Septic Shock Trial did not find a difference between low-dose vasopressin and norepinephrine vs. norepinephrine alone in the hemodynamic support of septic shock, suggesting that either approach is reasonable. However, vasopressin may be beneficial in the less severe septic shock subgroup. In this study, patients who were also treated with corticosteroids, vasopressin, compared with norepinephrine, were associated with significantly decreased mortality. Epinephrine, phenylephrine and terlipressin can be used safely in the ICU setting as first-line therapy for septic shock. The incidence of global left ventricular hypokinesia in patients with septic shock is 60%, much higher than previously described. Although dobutamine remains the gold standard therapy for septic myocardial depression, combined milrinone and metoprolol therapy may be an effective alternative therapy. Current evidence does not support a clear recommendation of one vasopressor over another; indeed norepinephrine, vasopressin, terlipressin, phenylephrine and epinephrine may be used safely with similar survival outcomes.

Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock

Central venous oxygen saturation (ScvO2) in initial resuscitation is included in the Surviving Sepsis Campaign guidelines. ScvO2 monitoring has also been suggested to be comparable to mixed venous oxygen saturation (SvO2) for clinical purposes. The aim of our study was to assess the correlation and agreement of ScvO2 and SvO2 and compare ScvO2-SvO2 difference to lactate, oxygen-derived and hemodynamic parameters in early septic shock in ICU after initial resuscitation. Prospective clinical study with 16 patients with septic shock at two university hospital ICUs. A dose of norepinephrine over 0.1 microg/kg/min was required for inclusion. Five paired ScvO2 and SvO2 samples at 6-h intervals, altogether 72 samples, were collected during 24 h. The mean SvO2 was below the mean ScvO2 at all time points. Bias of difference was 4.2% and 95% limits of agreement ranged from -8.1% to 16.5%. The difference correlated significantly to CI and DO2. The difference between paired ScvO2 and SvO2 varies highly. Therefore, SvO2 may not be estimated on the basis of ScvO2 in treatment of septic shock after resuscitation period in ICU.