Ventilatory Support of Patients with Sepsis or Septic Shock in Resource-Limited Settings

Neto, Ary Serpa; Schultz, Marcus J.; Festić, Emir; Adhikari, Neill K. J.; Dondorp, Arjen M.; Pattnaik, Rajyabardhan; Pisani, Luigi; Póvoa, Pedro; Martín‐Loeches, Ignacio; Thwaites, C. Louise

doi:10.1007/978-3-030-03143-5_6

Cited by 4 publications

(1 citation statement)

References 79 publications

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“…Given the high global burden of sepsis, great efforts have been made to improve its clinical outcomes. Interventions such as early goal-directed therapy, resuscitation bundles, protective ventilation, high-volume haemofiltration and immunomodulatory agents have been widely explored [ 3 – 7 ] and significant improvements in sepsis management and outcomes have been witnessed over the past few decades [ 8 , 9 ]. However, sepsis-related mortality and morbidity are still unacceptably high as estimated from the global disease burden database [ 2 ], and exploring novel therapeutic agents is a top research priority for sepsis/septic shock [ 10 ].…”

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confidence: 99%

Effectiveness of anisodamine for the treatment of critically ill patients with septic shock: a multicentre randomized controlled trial

Zhu

Hong

et al. 2021

Crit Care

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Background Septic shock is characterized by an uncontrolled inflammatory response and microcirculatory dysfunction. There is currently no specific agent for treating septic shock. Anisodamine is an agent extracted from traditional Chinese medicine with potent anti-inflammatory effects. However, its clinical effectiveness remains largely unknown. Methods In a multicentre, open-label trial, we randomly assigned adults with septic shock to receive either usual care or anisodamine (0.1–0.5 mg per kilogram of body weight per hour), with the anisodamine doses adjusted by clinicians in accordance with the patients’ shock status. The primary end point was death on hospital discharge. The secondary end points were ventilator-free days at 28 days, vasopressor-free days at 28 days, serum lactate and sequential organ failure assessment (SOFA) score from days 0 to 6. The differences in the primary and secondary outcomes were compared between the treatment and usual care groups with the χ2 test, Student’s t test or rank-sum test, as appropriate. The false discovery rate was controlled for multiple testing. Results Of the 469 patients screened, 355 were assigned to receive the trial drug and were included in the analyses—181 patients received anisodamine, and 174 were in the usual care group. We found no difference between the usual care and anisodamine groups in hospital mortality (36% vs. 30%; p = 0.348), or ventilator-free days (median [Q1, Q3], 24.4 [5.9, 28] vs. 26.0 [8.5, 28]; p = 0.411). The serum lactate levels were significantly lower in the treated group than in the usual care group after day 3. Patients in the treated group were less likely to receive vasopressors than those in the usual care group (OR [95% CI] 0.84 [0.50, 0.93] for day 5 and 0.66 [0.37, 0.95] for day 6). Conclusions There is no evidence that anisodamine can reduce hospital mortality among critically ill adults with septic shock treated in the intensive care unit. Trial registration ClinicalTrials.gov (NCT02442440; Registered on 13 April 2015).

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Section: Introductionmentioning

confidence: 99%

Effectiveness of anisodamine for the treatment of critically ill patients with septic shock: a multicentre randomized controlled trial

Zhu

Hong

et al. 2021

Crit Care

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Advances in Shock Management and Fluid Resuscitation in Children

Gupta

Sankar

2023

Indian J Pediatr

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Shock in children is associated with significant mortality and morbidity, particularly in resource-limited settings. The principles of management include early recognition, fluid resuscitation, appropriate inotropes, antibiotic therapy in sepsis, supportive therapy for organ dysfunction, and regular hemodynamic monitoring. During the past decade, each step has undergone several changes and evolved as evidence that has been translated into recommendations and practice. There is a paradigm shift from protocolized-based care to personalized management, from liberal strategies to restrictive strategies in terms of fluids, blood transfusion, ventilation, and antibiotics, and from clinical monitoring to multimodal monitoring using bedside technologies. However, uncertainties are still prevailing in terms of the volume of fluids, use of steroids, and use of extracorporeal and newer therapies while managing shock. These changes have been summarized along with evidence in this article with the aim of adopting an evidence-based approach while managing children with shock.

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Changes in central venous to arterial carbon dioxide gap (PCO₂gap) in response to acute changes in ventilation

et al. 2021

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BackgroundEarly diagnosis of shock is a predetermining factor for a good prognosis in intensive care. An elevated central venous to arterial PCO2 difference (∆PCO2) over 0.8 kPa (6 mm Hg) is indicative of low blood flow states. Disturbances around the time of blood sampling could result in inaccurate calculations of ∆PCO2, thereby misrepresenting the patient status. This study aimed to determine the influences of acute changes in ventilation on ∆PCO2 and understand its clinical implications.MethodsTo investigate the isolated effects of changes in ventilation on ∆PCO2, eight pigs were studied in a prospective observational cohort. Arterial and central venous catheters were inserted following anaesthetisation. Baseline ventilator settings were titrated to achieve an EtCO2 of 5±0.5 kPa (VT = 8 mL/kg, Freq = 14 ± 2/min). Blood was sampled simultaneously from both catheters at baseline and 30, 60, 90, 120, 180 and 240 s after a change in ventilation. Pigs were subjected to both hyperventilation and hypoventilation, wherein the respiratory frequency was doubled or halved from baseline. ∆PCO2 changes from baseline were analysed using repeated measures ANOVA with post-hoc analysis using Bonferroni’s correction.Results∆PCO2 at baseline for all pigs was 0.76±0.29 kPa (5.7±2.2 mm Hg). Following hyperventilation, there was a rapid increase in the ∆PCO2, increasing maximally to 1.35±0.29 kPa (10.1±2.2 mm Hg). A corresponding decrease in the ∆PCO2 was seen following hypoventilation, decreasing maximally to 0.23±0.31 kPa (1.7±2.3 mm Hg). These changes were statistically significant from baseline 30 s after the change in ventilation.ConclusionDisturbances around the time of blood sampling can rapidly affect the PCO2, leading to inaccurate calculations of the ∆PCO2, resulting in misinterpretation of patient status. Care should be taken when interpreting blood gases, if there is doubt as to the presence of acute and transient changes in ventilation.

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Ventilatory Support of Patients with Sepsis or Septic Shock in Resource-Limited Settings

Cited by 4 publications

References 79 publications

Effectiveness of anisodamine for the treatment of critically ill patients with septic shock: a multicentre randomized controlled trial

Effectiveness of anisodamine for the treatment of critically ill patients with septic shock: a multicentre randomized controlled trial

Advances in Shock Management and Fluid Resuscitation in Children

Changes in central venous to arterial carbon dioxide gap (PCO₂gap) in response to acute changes in ventilation

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Ventilatory Support of Patients with Sepsis or Septic Shock in Resource-Limited Settings

Cited by 4 publications

References 79 publications

Effectiveness of anisodamine for the treatment of critically ill patients with septic shock: a multicentre randomized controlled trial

Effectiveness of anisodamine for the treatment of critically ill patients with septic shock: a multicentre randomized controlled trial

Advances in Shock Management and Fluid Resuscitation in Children

Changes in central venous to arterial carbon dioxide gap (PCO2gap) in response to acute changes in ventilation

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Product

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Changes in central venous to arterial carbon dioxide gap (PCO₂gap) in response to acute changes in ventilation