How Best to Resuscitate Patients With Septic Shock?

Angus, Derek C.

doi:10.1001/jama.2019.0070

Cited by 10 publications

(6 citation statements)

References 2 publications

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“…To date, for sepsis severity assessment, blood lactate is the best biomarker [ 45 , 46 ], available in the prehospital setting [ 28 ], associated with survival [ 15 , 28 , 47 , 48 ]. In addition, lactate clearance represents an indirect tool for treatment effect assessment [ 7 , 21 ], usable to guide sepsis resuscitation [ 7 , 19 , 20 ], although subjected to controversies [ 49 , 50 ]. However, blood lactate point of care testing is not worldwide available in the prehospital setting.…”

Section: Discussionmentioning

confidence: 99%

Association between prehospital shock index variation and 28-day mortality among patients with septic shock

et al. 2022

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Purpose Septic shock (SS) hyperdynamic phase is characterized by tachycardia and low-blood pressure reflecting the relative hypovolemia. Shock index (SI), the ratio between heart rate and systolic blood pressure, is a simple objective tool, usable for SS prognosis assessment. This study aims to evaluate the relationship between prehospital SI variation and 28-day mortality of SS patients initially cared for in prehospital setting by a mobile intensive care unit (mICU). Methods From April 6th, 2016 to December 31st, 2020, 406 patients with SS requiring prehospital mICU were retrospectively analyzed. Initial SI, i.e. first measurement after mICU arrival to the scene, and final SI, i.e. last measurement of the prehospital stage, were used to calculate delta SI (initial SI—final SI) and to define positive and negative delta SI. A survival analysis after propensity score matching compared the 28-day mortality of SS patients with positive/negative delta SI. Results The main suspected origins of infection were pulmonary (42%), digestive (25%) and urinary (17%). The 28-day overall mortality reached 29%. Cox regression analysis revealed a significant association between 28-day mortality and delta SI. A negative delta SI was associated with an increase in mortality (adjusted hazard ratio (HRa) of 1.88 [1.07–3.31] (p = 0.03)), whereas a positive delta SI was associated with a mortality decrease (HRa = 0.53 [0.30–0.94] (p < 10–3)). Conclusion Prehospital hemodynamic delta SI among SS patients cared for by a mICU is associated with 28-day mortality. A negative prehospital delta SI could help physicians to identify SS with higher risk of 28-day mortality.

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Section: Discussionmentioning

confidence: 99%

Association between prehospital shock index variation and 28-day mortality among patients with septic shock

et al. 2022

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“…The anti-infection is often dominant in the imbalance between the pro-inflammatory and anti-infection. This leads to immunosuppression, which ultimately leads to MODS [17]. Th1 cells are characterized by the secretion of IL-2, IL-6, IFN-γ and other pro-inflammatory mediators.…”

Section: Regulatory T Cellmentioning

confidence: 99%

“…Sepsis is a common complication after severe trauma, burns, and shock. In recent years, advances has been achieved in anti-infection, fluid resuscitation, wound management, and organ support treatment for severe sepsis and septic shock [16,17]. The mortality rate of sepsis remains high and is the leading cause of death in ICU patients.…”

Section: Definition Of Sepsismentioning

confidence: 99%

The Importance of Detecting Regulatory T Cells in Neonatal Sepsis

Yao¹,

Shi²,

Zhang³

2019

Int J Crit Care Emerg Med

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can be defined as the fact that T cells do not proliferate under the stimulation of antigen and do not produce IL-2. Incompetence of T cells mediates immunosuppression. Inhibition refers to an active, immunomodulatory process that is mediated by regulatory T cells and that can be adoptively transferred. A large amount of research evidence indicates: Incompetence [7]. These cells and Tregs are the same cells at different stages of differentiation, that is, the incompetent cells are precursor cells of Tregs.CD4 + CD25 + CD127-Treg is the most important group. These Tregs are a typical subset of lymphocytes showing immune suppressive function, which selectively expressing molecular mark like CD25 (IL-2 receptor a), FOXP3, CTL4 (Cytotoxic T -Lymphocyte Antigen 4), LAE3 (Lymphocyte activating factor 3), TNFR (tumor necrosis factor receptor) and chemokine receptor 4,6,7,8,10. FOXP3 is specific marker of Tregs [8,9]. FOXP3 can activates the inhibiting function of CD4+ T cells which is important for differentiation and maturity of Tregs. They influence the immune balance by direct contacting with immune cells or secreting cytokines like IL-10, TGF-β [10]. They involve in various aspects of innate immune and adaptive immune like inhibiting CD4+ and CD8+ T cells functions, mediating lymphocyte differentiating from Th1 to Th2 and inducing lymphocytes apoptosis [11,12]. These Tregs also have effect on neutrophil and mononuclear macrophage to down-regulate their phagocytosis function [13]. When the host infected, the proportion of Treg will increase and results in immunosuppression [14]. The defect of Tregs will cause the severe hyperplasia of lymphoid tissue and hyperimmune activation. The important immune cells, like CD8 + and APCs (antigen presenting cell), Short reviewCheck for updates

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“…• the primary goal of this study -a 33% relative reduction in mortality rate based on a change in initial management strategy -is considerable and perhaps unrealistic. This highlights the need for appropriate targets in septic shock studies [11], and suggests this study was underpowered [12].…”

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confidence: 96%