Early (0-2 h) lactate clearance is an important and independent prognostic variable that should probably be incorporated in future decision schemes for the resuscitation of trauma patients.

BackgroundDespite the dissemination of international guidelines, mortality from septic shock remains high. Norepinephrine is recommended as first-line vasopressor therapy with a target mean arterial pressure of 65 mmHg. High-dose vasopressor (HDV) may also be required. This study aimed to assess survival in patients with septic shock requiring HDV. We conducted a retrospective study of patients admitted between January 2008 and December 2013 to a 13-bed ICU for septic shock and receiving high-dose vasopressor therapy (defined by a dose >1 µg/kg/min). Primary outcome was 28-day mortality (D28). Secondary outcomes were 90-day mortality (D90), organ failure score (SOFA), duration of organ failure, duration and dosage of vasopressor agent and ischemic complications.ResultsIn our cohort of 106 patients, mortality reached 60.4% at D28 and 66.3% at D90. One in two patients died before D10. The weight-based mean dose of vasopressor (WMD) represented the best prognostic factor. Using a cutoff of 0.75 µg/kg/min, WMD was associated with mortality with a sensitivity of 73% and specificity of 74%. The mortality rate reached 86.4% when WMD was above the cutoff value and associated with a SOFA score >10. Digital or limb necrosis was documented in 6 patients (5.7%).ConclusionsIn total, 40% of septic shock patients receiving high-dose vasopressor therapy survived at day 28 after admission. A WMD cutoff value of 0.75 µg/kg/min, associated with a >10 SOFA score, was a strong predictor of death. These results provide insights into outcome of refractory septic shock, showing that administration of high-dose vasopressor may indeed be useful in these patients.

Rupture of giant aneurysm of sinus of Valsalva usually requires surgery to prevent life-threatening complications from occurring. We report the case of a 55-year-old patient with a previous history of aortic valve replacement who was urgently referred to our institution with a superior vena cava syndrome and dyspnea. CT-scan initially misdiagnosed a dissection of the aortic root that was ultimately a contained rupture of a giant aneurysm of the non-coronary sinus of Valsalva. Despite a sudden hemodynamic deterioration with a collapse and cardiac arrest, urgent salvage surgery was successfully performed with an uneventful outcome. Physiopathogeny of hemodynamic profiles influencing immediate survival and surgical technique are discussed in this report.