BACKGROUND: Septic shock is highly lethal. We recently implemented an algorithm (advanced resuscitation algorithm for septic shock, ARAS 1) with a global survival of 67%, but with a very high mortality (72%) in severe cases [norepinephrine (NE) requirements >0.3 microg/kg/min for mean arterial pressure > or =70 mmHg]. As new therapies with different levels of evidence were proposed [steroids, drotrecogin alpha, high-volume hemofiltration (HVHF)], we incorporated them according to severity (NE requirements; algorithm ARAS-2), and constructed a multidisciplinary team to manage these patients from the emergency room (ER) to the ICU. The aim of this study was to compare the outcome of severe septic shock patients under both protocols. METHODS: Adult patients with severe septic shock were enrolled consecutively and managed prospectively with ARAS-1 (1999-2001), and ARAS-2 (2002-05). ARAS-2 incorporates HVHF for intractable shock. RESULTS: Thirty-three patients were managed with each protocol, without statistical differences in baseline demographics, APACHE II (22.2 vs 23.8), SOFA (11.4 vs 12.7) and NE peak levels (0.62 vs 0.8 microg/kg/min). The 28-day mortality and epinephrine use were higher with ARAS-1 (72.7% vs 48.5%; 87.9% vs 18.2 %); and low-dose steroids (35.9% vs 72.7%), drotrecogin (0 vs 15 %) and HVHF use (3.0% vs 39.4%) were higher for ARAS-2 (P<0.05 for all). CONCLUSION: Management of severe septic shock with a multidisciplinary team and an updated protocol (according to the best current evidence), with precise entry criteria for every intervention at different stages of severity, may improve survival in these patients. Multidisciplinary management, rationalization of the use of vasoactives and rescue therapy based on HVHF instead of epinephrine may have contributed to these RESULTS: Management of severe septic shock with these kinds of algorithms is feasible and should be encouraged.
BACKGROUND:Septic shock is highly lethal. We recently implemented an algorithm (advanced resuscitation algorithm for septic shock, ARAS 1) with a global survival of 67%, but with a very high mortality (72%) in severe cases [norepinephrine (NE) requirements >0.3 microg/kg/min for mean arterial pressure > or =70 mmHg]. As new therapies with different levels of evidence were proposed [steroids, drotrecogin alpha, high-volume hemofiltration (HVHF)], we incorporated them according to severity (NE requirements; algorithm ARAS-2), and constructed a multidisciplinary team to manage these patients from the emergency room (ER) to the ICU. The aim of this study was to compare the outcome of severe septic shockpatients under both protocols. METHODS: Adult patients with severe septic shock were enrolled consecutively and managed prospectively with ARAS-1 (1999-2001), and ARAS-2 (2002-05). ARAS-2 incorporates HVHF for intractable shock. RESULTS: Thirty-three patients were managed with each protocol, without statistical differences in baseline demographics, APACHE II (22.2 vs 23.8), SOFA (11.4 vs 12.7) and NE peak levels (0.62 vs 0.8 microg/kg/min). The 28-day mortality and epinephrine use were higher with ARAS-1 (72.7% vs 48.5%; 87.9% vs 18.2 %); and low-dose steroids (35.9% vs 72.7%), drotrecogin (0 vs 15 %) and HVHF use (3.0% vs 39.4%) were higher for ARAS-2 (P<0.05 for all). CONCLUSION: Management of severe septic shock with a multidisciplinary team and an updated protocol (according to the best current evidence), with precise entry criteria for every intervention at different stages of severity, may improve survival in these patients. Multidisciplinary management, rationalization of the use of vasoactives and rescue therapy based on HVHF instead of epinephrine may have contributed to these RESULTS: Management of severe septic shock with these kinds of algorithms is feasible and should be encouraged.
Authors: Brian Casserly; Michael Baram; Patricia Walsh; Andrew Sucov; Nicholas S Ward; Mitchell M Levy Journal: Lung Date: 2010-11-16 Impact factor: 2.584
Authors: Greg Martin; Frank M Brunkhorst; Jonathan M Janes; Konrad Reinhart; David P Sundin; Kassandra Garnett; Richard Beale Journal: Crit Care Date: 2009-06-30 Impact factor: 9.097
Authors: R Beale; K Reinhart; F M Brunkhorst; G Dobb; M Levy; G Martin; C Martin; G Ramsey; E Silva; B Vallet; J-L Vincent; J M Janes; S Sarwat; M D Williams Journal: Infection Date: 2009-04-28 Impact factor: 3.553
Authors: Robert Sbertoli; Zeyu Hu; Jonathan Henke; Eric Wu; Shrihari Santosh; Stephen Osmon; Edward Charbek; Zafar Jamkhana; Sadashiv Santosh Journal: Crit Care Explor Date: 2020-04-29
Authors: Emma Mj Borthwick; Christopher J Hill; Kannaiyan S Rabindranath; Alexander P Maxwell; Danny F McAuley; Bronagh Blackwood Journal: Cochrane Database Syst Rev Date: 2017-01-31
Authors: Glenn Hernandez; Tomas Regueira; Alejandro Bruhn; Ricardo Castro; Maximiliano Rovegno; Andrea Fuentealba; Enrique Veas; Dolores Berrutti; Jorge Florez; Eduardo Kattan; Celeste Martin; Can Ince Journal: Ann Intensive Care Date: 2012-10-15 Impact factor: 6.925
Authors: Glenn Hernandez; Alejandro Bruhn; Ricardo Castro; Cesar Pedreros; Maximiliano Rovegno; Eduardo Kattan; Enrique Veas; Andrea Fuentealba; Tomas Regueira; Carolina Ruiz; Can Ince Journal: Crit Care Res Pract Date: 2012-04-18