Tag Archives: shock

Predicting Fluid Responsiveness by Passive Leg Raising

Passive leg raising creates a reversible increase in venous return, allowing for the prediction of fluid responsiveness. However, the amount of venous return may vary in various clinical settings, potentially affecting the diagnostic performance of passive leg raising. Therefore, Cherpanath et al performed a systematic meta-analysis determining the diagnostic performance of passive leg raising in different clinical settings with exploration of patient characteristics, measurement techniques and outcome variables.

They found that passive leg raising retains a high diagnostic performance in various clinical settings and patient groups. They also found that the predictive value of a change in pulse pressure on passive leg raising is inferior to a passive leg raising-induced change in a flow variable.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Higher Versus Lower Blood Pressure Targets for Vasopressor Therapy in Shock

In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. Lamontagne et al conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock.

They concluded that their pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy.

Read the full Concise Critical Appraisal by logging in to the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Diastolic Dysfunction in Children with Fluid Refractory Septic Shock

The presence of cardiac dysfunction in patients with septic shock has been described for decades. However, the true prevalence or ultimate effect of diastolic dysfunction has only been described in septic children in limited fashion. Sankar et al analyzed 56 children (all between three months and 17 years of age) with fluid refractory septic shock, before inotropes or mechanical ventilation were initiated. The primary objectives of this study were to determine the prevalence of diastolic dysfunction in children with fluid refractory septic shock and to determine if there was an association between diastolic dysfunction and mortality.

The authors demonstrated that diastolic dysfunction in children with fluid refractory septic shock is relatively common, similar to some adult findings. Interestingly, children with diastolic dysfunction and those with no cardiac dysfunction had higher mortality rates than those with systolic dysfunction (43%, 37% and 15%, respectively), though these differences were not statistically significant. In the wake of this study, questions still linger about the true prevalence of diastolic dysfunction in children with fluid refractory septic shock. Further studies are needed to confirm these findings.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Protocol-based Resuscitation Versus Usual Care for Septic Shock

Early protocolized care has become the standard since the 2001 trial by Rivers et al, which demonstrated 16% greater survival when patients with severe sepsis or septic shock were treated with a six-hour protocol of early, aggressive goal-directed therapy (EGDT). However, it is unclear which elements of the Rivers protocol are most beneficial. The Protocolized Care for Early Septic Shock (ProCESS) investigators, led by Derek Angus from the University of Pittsburgh, performed a multicenter trial comparing alternative resuscitation strategies for patients with septic shock.

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There’s Still Time to Join an SSC Local Collaborative

SSC LogoThe Surviving Sepsis Campaign (SSC) is launching a quality improvement initiative to increase early recognition and treatment of sepsis in patients on hospital medical, surgical and telemetry units. It is seeking hospitals to participate in collaboratives in San Francisco, Chicago and the East Coast (meeting in Providence, RI). Be part of the SSC collaboratives. The application deadline has been extended, and applications are now due by November 30, 2013.

The aim of this new initiative is to study, test and disseminate tools related to the early identification and treatment of sepsis on hospital floors. Participating hospitals will select one unit to enroll in this pilot project. During the course of the collaborative, hospitals that experience significant improvements may choose to implement changes in other units outside the collaborative. At the end of the collaborative, a consensus statement will be produced along with change/tool packages free to hospitals interested in improving their own care.

The SSC Collaborative initiative is made possible through a generous grant from the Gordon and Betty Moore Foundation to continue the work of the SSC in the United States. There is no fee to join the collaborative. The Foundation’s support covers the costs of the faculty, collaborative project management, database support and benchmarking, virtual meeting support, and other related expenses.

The SSC Data Collection Tool is now available. Hospitals worldwide are encouraged to download this tool to improve the care of sepsis patients. Collecting data helps improve outcomes and inform benchmarking data. Hospitals seeking to download the Data Collection Tool should seek the help of their Information Technology Department.

The SSC has recently released new resources, including: