Shock treatment in a cohort of Scandinavian intensive care units in 2014

Kollind, Malin; Wickbom, Fredrik; Snäckestrand, M; Holmén, Anders; Oldner, Anders; Perner, Anders; Åneman, Anders; Chew, Michelle

doi:10.1111/aas.12745

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…The high number of patients receiving mechanical ventilation in combination with vasopressors/inotropes is in agreement with results from a recent survey of Scandinavian ICUs, where mechanical ventilation was used in 80% of patients who also received vasopressors for shock . RRT was most often used in combination with other life support modalities.…”

Section: Discussionsupporting

confidence: 88%

“…RRT is less commonly used; recent data indicate that approximately 10% of ICU patients receive RRT . Several life support modalities are frequently used concomitantly; the majority of patients with shock receive both vasopressors and mechanical ventilation, and in ICU patients treated with continuous RRT, mechanical ventilation and vasopressors/inotropes has been reported in approximately 80%…”

mentioning

confidence: 99%

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Use of life support in acutely admitted ICU patients. An international cohort study

Meyhoff

Krag

Hjortrup

et al. 2017

Acta Anaesthesiol Scand

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Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

Use of life support in acutely admitted ICU patients. An international cohort study

Meyhoff

Krag

Hjortrup

et al. 2017

Acta Anaesthesiol Scand

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“…The choice of first-line vasopressor in our survey agrees with reports from Scandinavian and Canadian ICUs where norepinephrine was the first-line vasopressor used to achieve MAP targets [32, 33]. This is a significant change from an earlier survey where dopamine was the first-line vasopressor [34].…”

Section: Discussionsupporting

confidence: 85%

“…The methods used to invite individuals to respond to our survey did not allow us to calculate the exact response rate, which can be estimated to around 10% of all ESICM members. Nevertheless, our survey had by far the largest absolute number of respondents as compared to previous surveys on vasopressors (839 vs. 114, 171, and 202, respectively) [32–34]. Still, a response bias cannot be excluded.…”

Section: Discussionmentioning

confidence: 85%

Current use of vasopressors in septic shock

Scheeren

Bakker

Backer

et al. 2019

Ann. Intensive Care

127

123

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BackgroundVasopressors are commonly applied to restore and maintain blood pressure in patients with sepsis. We aimed to evaluate the current practice and therapeutic goals regarding vasopressor use in septic shock as a basis for future studies and to provide some recommendations on their use.MethodsFrom November 2016 to April 2017, an anonymous web-based survey on the use of vasoactive drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 17 questions focused on the profile of respondents, triggering factors, first choice agent, dosing, timing, targets, additional treatments, and effects of vasopressors. We investigated whether the answers complied with current guidelines. In addition, a group of 34 international ESICM experts was asked to formulate recommendations for the use of vasopressors based on 6 questions with sub-questions (total 14).ResultsA total of 839 physicians from 82 countries (65% main specialty/activity intensive care) responded. The main trigger for vasopressor use was an insufficient mean arterial pressure (MAP) response to initial fluid resuscitation (83%). The first-line vasopressor was norepinephrine (97%), targeting predominantly a MAP > 60–65 mmHg (70%), with higher targets in patients with chronic arterial hypertension (79%). The experts agreed on 10 recommendations, 9 of which were based on unanimous or strong (≥ 80%) agreement. They recommended not to delay vasopressor treatment until fluid resuscitation is completed but rather to start with norepinephrine early to achieve a target MAP of ≥ 65 mmHg.ConclusionReported vasopressor use in septic shock is compliant with contemporary guidelines. Future studies should focus on individualized treatment targets including earlier use of vasopressors.

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“…However, international guidelines lack firm evidence for the optimal volume. 1 Patients with septic shock in the intensive care unit (ICU) may receive IV fluids according to several indications: 2,3 to improve hemodynamics, replace fluid loss, correct electrolyte imbalance or dehydration, as maintenance fluid, as a carrier for medication, or as nutrition. [4][5][6] Administration of IV fluids in the ICU may lead to over-hydration, which has been associated with adverse outcomes, [7][8][9] and data from randomised clinical trials (RCTs) both in a pre-clinical 10 and a clinical setting [11][12][13][14][15] have raised concerns about harms from higher IV fluid volumes.…”

Section: Introductionmentioning

confidence: 99%

Conservative vs liberal fluid therapy in septic shock (CLASSIC) trial—Protocol and statistical analysis plan

Meyhoff

Hjortrup

Møller

et al. 2019

Acta Anaesthesiol Scand

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Introduction Intravenous (IV) fluid is a key intervention in the management of septic shock. The benefits and harms of lower versus higher fluid volumes are unknown and clinical equipoise exists. We describe the protocol and detailed statistical analysis plan for the Conservative versus Liberal Approach to fluid therapy of Septic Shock in the Intensive Care (CLASSIC) trial. The aim of the CLASSIC trial is to assess benefits and harms of IV fluid restriction versus standard care in adult intensive care unit (ICU) patients with septic shock. Methods CLASSIC trial is an investigator-initiated, international, randomised, stratified, and analystblinded trial. We will allocate 1554 adult patients with septic shock, who are planned to be or are admitted to an ICU, to IV fluid restriction versus standard care. The primary outcome is mortality at day 90. Secondary outcomes are serious adverse events, serious adverse reactions, days alive at day 90 without life support, days alive and out of hospital at day 90, and mortality, health-related quality of life, and cognitive function at 1 year. We will conduct the statistical analyses according to a pre-defined statistical analysis plan, including three interim analyses. For the primary analysis we will use logistic regression adjusted for the stratification variables comparing the two interventions in the intention-to-treat population. Discussion The CLASSIC trial results will provide important evidence to guide clinicians' choice regarding IV fluid therapy in adults with septic shock.

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Shock treatment in a cohort of Scandinavian intensive care units in 2014

Cited by 6 publications

References 34 publications

Use of life support in acutely admitted ICU patients. An international cohort study

Use of life support in acutely admitted ICU patients. An international cohort study

Current use of vasopressors in septic shock

Conservative vs liberal fluid therapy in septic shock (CLASSIC) trial—Protocol and statistical analysis plan

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