Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet?

Sánchez, Elizabeth; Pinsky, Michael R.; Sinha, Sharmili; Mishra, Rajesh; Lopa, Ahsina Jahan; Chatterjee, Ranajit

doi:10.2478/jccm-2023-0022

Cited by 7 publications

(3 citation statements)

References 74 publications

(115 reference statements)

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“…The removal of mechanical ventilation in patients with pre-existing cardiac or respiratory issues poses risks of pulmonary edema and respiratory failure. Spontaneous breathing after ventilation increases preload, catecholamine release, and oxygen consumption, potentially leading to respiratory muscle fatigue and left ventricular dysfunction [ 23 , 24 ]. Additionally, patients with airway obstruction may experience increased loads due to intrinsic positive end-expiratory pressure (PEEPi) and high airway resistance [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous breathing after ventilation increases preload, catecholamine release, and oxygen consumption, potentially leading to respiratory muscle fatigue and left ventricular dysfunction [ 23 , 24 ]. Additionally, patients with airway obstruction may experience increased loads due to intrinsic positive end-expiratory pressure (PEEPi) and high airway resistance [ 24 , 25 ]. Our study, indicating that most readmitted ICU patients had respiratory failure, supports this concern.…”

Section: Discussionmentioning

confidence: 99%

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Determinants of Readmission in the Intensive Care Unit: A Prospective Observational Study

Kumar,

Singh,

Arshad

et al. 2024

Cureus

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Background The antecedents of readmission among survivors of intensive care units (ICUs) are complex and comprise an array of elements that impact the rehabilitation process after leaving the ICU. The aforementioned determinants may comprise socioeconomic factors, access to follow-up healthcare, the nature and severity of the initial illness or injury, the presence of comorbidities, the sufficiency of transitional care and rehabilitation services, and patient and family support systems. Added to this, the risk of readmission may be increased by complications that develop during the ICU stay, including but not limited to infections, organ dysfunction, and psychological distress. Comprehending these determinants is of the utmost importance for healthcare providers in order to execute focused interventions that seek to diminish readmission rates, enhance patient outcomes, and elevate the standard of care for survivors of ICUs. Objective The objective of the study is to determine the factors associated with readmission among ICU survivors and the cause of readmission. Methodology This prospective observational study was conducted in a tertiary-level ICU. The duration of the study was one year and we enrolled 108 ICU survivors in our study. We have recorded patient demographic data, comorbidity, primary diagnosis, previous treatment history (vasopressor, sedation), causes of readmission, duration of previous ICU stay, and outcome of readmitted patient (discharge, death, and transfer to lower facility). Result The incidence of readmission in our ICU is 10.4%; 50-70 age groups are more prone to readmission of which the male sex is predominant (64.81%). In our study, hypertension (cardiac, 18.52%) and diabetes mellitus (11.11%) were the most common comorbidities reported in readmitted patients. The majority of patients who get readmission suffered from blunt trauma abdomen. In the majority of readmitted patients, sedation was used in the previous admission for ventilation and patient comfort (66.67%). Most of the readmitted patients (68.51%) have a previous ICU stay of more than five days. Patients were readmitted mainly because of respiratory (30.56%) and neurological (25%) complications. In this study, readmitted patients have high mortality (59.26%). Conclusion In a tertiary care ICU, the incidence rate of readmitted patients was 10.4%. Respiratory and neurological problems were the main cause of readmission. In readmitted patients, mortality was high up to 59.26%. Old age, male sex, prolonged ICU stay, comorbidities like hypertension, blunt trauma abdomen, use of sedation, and prolonged mechanical ventilation in previous ICU admission are major risk factors for ICU readmission.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Determinants of Readmission in the Intensive Care Unit: A Prospective Observational Study

Kumar,

Singh,

Arshad

et al. 2024

Cureus

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“…rgan perfusion is compromised during critical illness, and its optimization is a primary goal of treatment (1)(2)(3)(4)(5)(6). Mean arterial pressure (MAP), the product of cardiac output and systemic vascular resistance, is a key determinant of tissue perfusion (7). MAPs below a threshold, usually understood to be approximately 60 mm Hg, are associated with decreased organ perfusion (8).…”

mentioning

confidence: 99%

Linear Correlation Between Mean Arterial Pressure and Urine Output in Critically Ill Patients

Lichter,

Gal Oz,

Adi

et al. 2024

Critical Care Explorations

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OBJECTIVE: Mean arterial pressure (MAP) plays a significant role in regulating tissue perfusion and urine output (UO). The optimal MAP target in critically ill patients remains a subject of debate. We aimed to explore the relationship between MAP and UO. DESIGN: A retrospective observational study. SETTING: A general ICU in a tertiary medical center. PATIENTS: All critically ill patients admitted to the ICU for more than 10 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: MAP values and hourly UO were collected in 5,207 patients. MAP levels were categorized into 10 groups of 5 mm Hg (from MAP < 60 mm Hg to MAP > 100 mg Hg), and 656,423 coupled hourly mean MAP and UO measurements were analyzed. Additionally, we compared the UO of individual patients in each MAP group with or without norepinephrine (NE) support or diuretics, as well as in patients with acute kidney injury (AKI). Hourly UO rose incrementally between MAP values of 65–100 mm Hg. Among 2,226 patients treated with NE infusion, mean UO was significantly lower in the MAP less than 60 mm Hg group (53.4 mL/hr; 95% CI, 49.3–57.5) compared with all other groups (p < 0.001), but no differences were found between groups of 75 less than or equal to MAP. Among 2500 patients with AKI, there was a linear increase in average UO from the MAP less than 60 mm Hg group (57.1 mL/hr; 95% CI, 54.2–60.0) to the group with MAP greater than or equal to 100 mm Hg (89.4 mL/hr; 95% CI, 85.7–93.1). When MAP was greater than or equal to 65 mm Hg, we observed a statistically significant trend of increased UO in periods without NE infusion. CONCLUSIONS: Our analysis revealed a linear correlation between MAP and UO within the range of 65–100 mm Hg, also observed in the subgroup of patients treated with NE or diuretics and in those with AKI. These findings highlight the importance of tissue perfusion to the maintenance of diuresis and achieving adequate fluid balance in critically ill patients.

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Rubber-banding and the phenomenon of global hypoperfusion

Avritt,

Srour

2024

Medical Hypotheses

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Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet?

Cited by 7 publications

References 74 publications

Determinants of Readmission in the Intensive Care Unit: A Prospective Observational Study

Determinants of Readmission in the Intensive Care Unit: A Prospective Observational Study

Linear Correlation Between Mean Arterial Pressure and Urine Output in Critically Ill Patients

Rubber-banding and the phenomenon of global hypoperfusion

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