Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update

Hollenberg, Steven M.; Ahrens, Tom; Annane, Djillali; Astiz, Mark E.; Chalfin, Donald B.; Dasta, Joseph F.; Heard, Stephen O.; Martin, Claude; Napolitano, Lena M.; Susla, Gregory M.; Totaro, Richard; Vincent, Jean‐Louis; Zanotti-Cavazzoni, S.L.

doi:10.1097/01.ccm.0000139761.05492.d6

Cited by 446 publications

(327 citation statements)

References 208 publications

(152 reference statements)

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“…17,18 Six to 10 L of fluid may be administered in the first 24 hr of management. 5 Indeed, in the Rivers' goal directed resuscitation trial of septic shock, patients in the goal directed group received a mean of 5.0 (± SD 3.0) as compared to 3.5 (± SD 2.4) L of fluid in the standard therapy arm in just the first six hours of care.…”

Section: Discussionmentioning

confidence: 99%

Réanimation des patients en début de sepsie sévère: Une étude observationnelle multi-centrique canadienne

McIntyre

Fergusson

Cook

et al. 2007

Can J Anesth/J Can Anesth

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Background: Fluid resuscitation is a key factor in restoring hemodynamic stability and tissue perfusion in patients with severe sepsis. We sought to examine associations of the quantity and type of fluid administered in the first six hours after identification of severe sepsis and hospital mortality, intensive care unit (ICU) mortality, and organ failure. Methods:A retrospective, multicentre cohort study was undertaken at five Canadian tertiary care ICUs. We identified patients with severe sepsis admitted to the ICU between July 1, 2000, and June 30, 2002, using both administrative and clinical databases. Patients were included if they were hypotensive, had an infectious source, and at least two systemic inflammatory response syndrome criteria. We recorded total quantity and type of fluid administered for the first six hours after severe sepsis was identified. The first episode of hypotension defined the starting point for collection of fluid data. Multivariable regression analyses were performed to examine associations between quantity and type of fluid administered and hospital/ICU mortality, and organ failure.Results: Of 2,026 potentially eligible patient charts identified, 496 patients met eligibility criteria. The mean age and Acute Physiology and Chronic Health Evaluation score (APACHE II) were 61.8 ± 16.5 yr and 29.0 ± 8.0, respectively. No associations between quantity or type of fluid administered and hospital mortality or ICU mortality were identified, and there were no statistically significant associations between quantity or type of fluid administered and organ failure. However, more fluid resuscitation was associated with an increased risk of cardiovascular failure [odds ratio (OR) and 95% confidence interval Conclusion:An association between hospital mortality and quantity or type of fluid administered in the first six hours after the diagnosis of severe sepsis was not identifiable. These findings should be considered as hypothesis-generating and warrant confirmation or refutation by randomized controlled trials.

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Section: Discussionmentioning

confidence: 99%

Réanimation des patients en début de sepsie sévère: Une étude observationnelle multi-centrique canadienne

McIntyre

Fergusson

Cook

et al. 2007

Can J Anesth/J Can Anesth

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“…Hydrocortisone administration was started with a loading dose of 100 mg, administered intravenously in 30 min, followed by continuous infusion of 0.18 mg/kg/h. According to the SCCM guidelines, either continuous infusion of 200-300 mg hydrocortisone/day for 7 days with subsequent dose reduction, or low-dose application of 50-75 mg hydrocortisone four times a day is recommended for the management of patients with septic shock (32). After reversal of septic shock (defined as dopamine doses of -6 mg/kg/min or cessation of norepinephrine/ epinephrine infusion) the dose of hydrocortisone was reduced to 0.08 mg/kg/h.…”

Section: Interventionsmentioning

confidence: 99%

Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock

Mussack¹,

Briegel²,

Schelling³

et al. 2005

Clinical Chemistry and Laboratory Medicine (CCLM)

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Stress doses of hydrocortisone are known to have immunomodulatory effects in patients with hyperdynamic septic shock. The prognosis correlates with the presence and severity of septic encephalopathy. However, neurological evaluation is influenced by the use of analgesia sedation during artificial ventilation. The objective of this study was to demonstrate the effect of stress doses of hydrocortisone during the initial phase of human septic shock on the serum values of the neurospecific protein S-100B in comparison to the inflammation markers interleukin (IL)-8 in serum and polymorphonuclear (PMN) elastase in plasma. A total of 24 consecutive patients, who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock, were enrolled in this prospective, randomized, double-blind, singlecenter trial. The severity of illness at recruitment was graded using the Acute Physiology and Chronic Health Evaluation II and the Simplified Acute Physiology Score II scoring systems. Multi-organ dysfunction syndrome was described by the Sepsis-related Organ Failure Assessment (SOFA) score. All patients were prospectively randomized to receive either stress doses of hydrocortisone or placebo. Hydrocortisone was started in 12 patients with a loading dose of 100 mg and followed by a continuous infusion of 0.18 mg/kg/h for 6 days. Median S-100B serum levels of the hydrocortisone group decreased from 0.32 ng/mL at study entry to 0.07 ng/mL 6 days later without significant differences compared to the placebo group. Initial IL-8 serum levels were significantly higher in the hydrocortisone group up to 12 h after study entry, and significantly decreased from 715 to 17 pg/mL at the end of the observation period. Median PMN elastase plasma levels were not affected by hydrocortisone infusion. Patients with initial S-100B *Corresponding author: Thomas Mussack, MD, Department of Surgery Innenstadt, Klinikum der Universitä t Mü nchen, Nussbaumstraße 20, 80336 Mü nchen, Germany Phone: q49-89-5160-2638, Fax: q49-89-5160-4489, E-mail: thomas.mussack@med.uni-muenchen.de serum levels )0.50 ng/mL revealed significantly higher SOFA scores up to 30 h, IL-8 serum levels up to 12 h, and PMN elastase plasma levels up to 36 h after study entry than those patients with F0.50 ng/mL. These effects were independent of the amount of fluid correction for hemodilution. Starting S-100B, IL-8 and PMN elastase values of the hydrocortisone group were within the ranges already known in patients with out-of-hospital cardiac arrest or severe traumatic brain injury. Stress doses of hydrocortisone resulted in a significant reduction in IL-8 serum, but not in S-100B serum and PMN elastase plasma concentrations in patients with hyperdynamic septic shock. For the first time, a similar extent of S-100B increase in serum of septic patients at the time of diagnosis was shown as reported for cardiac arrest or severe traumatic brain injury.

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“…Fluid administration should be performed vigorously and titrated to clinical endpoints of perfusion such as capillary refill, urine output, and mental status, and also to macrocirculatory parameters of global perfusion, including heart rate, blood pressure, cardiac output, and mixed or central venous oxygen saturation [1]. In sepsis, however, tissue hypoperfusion may result not only from decreased perfusion pressure attributable to hypotension but also from abnormal distribution of blood flow [1,2]. Thus, defining the adequacy of resuscitation requires attention to both global and regional perfusion.…”

mentioning

confidence: 99%

“…It seems clear that measures to support hemodynamics after presentation with sepsis are most effective when applied early [16], and the improvement in microcirculation perfusion has been shown to correlate with improvements in organ function in the early phases of sepsis [13]. Whether patients in whom macrocirculatory goals have been achieved should be resuscitated to microcirculatory endpoints has not been established, and is the subject of ongoing investigation [3].…”

mentioning

confidence: 99%

Think locally: evaluation of the microcirculation in sepsis

Hollenberg

2010

Intensive Care Med

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Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update

Cited by 446 publications

References 208 publications

Réanimation des patients en début de sepsie sévère: Une étude observationnelle multi-centrique canadienne

Réanimation des patients en début de sepsie sévère: Une étude observationnelle multi-centrique canadienne

Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock

Think locally: evaluation of the microcirculation in sepsis

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