Indigenous Patients with Community Acquired Septic Shock Receive the Same Standard of Care as Non-Indigenous Patients in the Top End of Northern Territory, Australia

Brett G Sampson; Joshua S Davis; Lai Kin Yaw; Helena A White; Didier J Palmer; Dianne P Stephens

doi:10.19104/jemi.2015.103

Evaluation of admission serum magnesium levels in patients with septic shock and its correlation with outcome

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195663 ◽

2019 ◽

Vol 7 (1) ◽

pp. 155

Author(s):

Akshay R. Khare ◽

Vishwanath C. Patil ◽

Jignesh N. Shah ◽

Shivakumar S. Iyer

Keyword(s):

Septic Shock ◽

Sofa Score ◽

Serum Magnesium ◽

Length Of Hospital Stay ◽

Standard Of Care ◽

Suspected Infection ◽

Time Period ◽

Increased Risk ◽

Standard Of Care Treatment ◽

Organ Dysfunctions

Background: Admission hypomagnesemia has been linked with an increased risk of septic shock. The purpose of this study was to evaluate admission serum magnesium levels in patients with septic shock and to determine its correlation with the outcomes.Methods: It was a prospective observational study. Total 50 patients fitting the Sepsis-3 definition between time period of June 2017 to November 2018 were included in the study. Patients with suspected infection were identified at the bedside with qSOFA. Admission serum magnesium levels was measured for all patients included. APACHE II scores were calculated at the end of 24 hours after admission. Routine standard of care treatment was provided to all patients. The patients were monitored for organ dysfunctions based on daily SOFA scores, ventilator free days, vasopressors free days, dialysis free days, length of intensive care unit stay, length of hospital stay. The data was analysed using Statistical Package for Social Sciences for MS Windows.Results: In this study hypomagnesemia was prevalent in 18%, normomagnesemia in 62% and hypermagnesemia in 20% of total included patients. The mean vasopressor free days in Hypomagnesemia group (7.11±12.79 days) were higher than those in normomagnesemic patients (5.06±5.51 days) and hypermagnesemia patients (1.70±3.09 days). Out of total 50 patients 18 died and 32 recovered. 11 patients out of 32 who recovered had abnormal admission serum magnesium levels whereas 8 pts out of 18 who died had abnormal admission serum magnesium levels. SOFA score in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients was statistically significant.Conclusions: Author did not find any statistically significant correlation between admission magnesium levels in septic shock patients and outcomes although SOFA score was higher in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients. Serum magnesium may not truly reflect body’s magnesium status. RBC magnesium may need to be studied to see whether it is a more reliable biomarker.

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Early administration of Vitamin C in patients with sepsis or septic shock in emergency departments: A multicenter, double blinded, randomized controlled trial: The C-EASIE trial protocol

PLoS ONE ◽

10.1371/journal.pone.0259699 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259699

Author(s):

Stefanie Vandervelden ◽

Lina Wauters ◽

Jan Breuls ◽

Steffen Fieuws ◽

Philippe Vanhove ◽

...

Keyword(s):

Septic Shock ◽

Vitamin C ◽

Controlled Trial ◽

Intervention Group ◽

Length Of Hospital Stay ◽

Standard Of Care ◽

Early Administration ◽

Threatening Condition ◽

Registration Number ◽

Double Blinded

Background Sepsis is a potentially life-threatening condition characterized by a deregulated body’s response to infection causing injury to its own tissues and organs. Sepsis is the primary cause of death from infection. If not recognized and treated timely, it can evolve within minutes/hours to septic shock. Sepsis is associated with an acute deficiency of Vitamin C. Despite the proof-of-concept of the benefit of administering Vitamin C in patients with sepsis or septic shock, Vitamin C administration is not yet current practice. Objective To investigate the potential benefit of early administration of high doses of Vitamin C in addition to standard of care in patients with sepsis or septic shock. Methods This phase 3b multi-center trial is conducted in 8 hospitals throughout Belgium. In total 300 patients will be randomly assigned to one of two groups in a 1:1 allocation ratio. The intervention group will receive 1.5 g Vitamin C 4 times a day during 4 days, started within 6 hours after admission. The primary outcome is the average post-baseline patient SOFA score. Conclusion This trial will determine whether the early administration of Vitamin C in patients with sepsis or septic shock can lead to a more rapid solution of shock and less deterioration from sepsis to septic shock, hereby reducing morbidity and mortality as well as the length of hospital stay in this patient population. Trial registration The C-EASIE trial has been registered on the ClinicalTrials.gov website on 10 February 2021 with registration number NCT04747795. Trial Sponsor UZ Leuven (sponsor’s reference S63213)

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Polyclonal Intravenous Immunoglobulin for the Prophylaxis and Treatment of Infection in Critically Ill Adults

Canadian Journal of Infectious Diseases ◽

10.1155/2002/127953 ◽

2002 ◽

Vol 13 (2) ◽

pp. 100-106 ◽

Cited By ~ 9

Author(s):

Kevin B Laupland

Keyword(s):

Septic Shock ◽

Intravenous Immunoglobulin ◽

Critically Ill ◽

Meta Analysis ◽

Standard Of Care ◽

Streptococcal Toxic Shock Syndrome ◽

Clinical Equipoise ◽

Recommended Treatment ◽

Critically Ill Adults ◽

Sepsis And Septic Shock

Infection is a major cause of morbidity and mortality in critically ill patients. Despite advances in technology, its mortality rate has changed minimally over the past two decades, and new therapies are needed. Polyclonal intravenous immunoglobulin (IVIG) has been investigated both as a preventive and a treatment modality for sepsis and septic shock in critically ill adult patients. Prophylaxis with IVIG has been shown to reduce significantly the incidence of infection, particularly pneumonia, in selected postsurgical intensive care patients. However, it does not reduce mortality. The risk-benefit and cost effectiveness of this therapeutic intervention have not been determined, and its routine use is therefore not recommended. Treatment with IVIG has been shown in a number of small trials and a meta-analysis to reduce dramatically sepsis and septic shock mortality. However, a large, unpublished randomized trial has apparently shown no mortality benefit with this therapy. Despite limited evidence, IVIG has become the standard of care for the management of group A streptococcal toxic shock syndrome. At present, clinical equipoise exists for the use of IVIG in the treatment of sepsis and septic shock, and further study is needed.

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Modulation of the sigma-1 receptor–IRE1 pathway is beneficial in preclinical models of inflammation and sepsis

Science Translational Medicine ◽

10.1126/scitranslmed.aau5266 ◽

2019 ◽

Vol 11 (478) ◽

pp. eaau5266 ◽

Cited By ~ 26

Author(s):

Dorian A. Rosen ◽

Scott M. Seki ◽

Anthony Fernández-Castañeda ◽

Rebecca M. Beiter ◽

Jacob D. Eccles ◽

...

Keyword(s):

Septic Shock ◽

Inflammatory Response ◽

Standard Of Care ◽

Multiple Organ ◽

Preclinical Model ◽

Blood Leukocytes ◽

Sigma 1 Receptor ◽

Tissue Hypoperfusion ◽

Sigma 1 ◽

New Treatments

Sepsis is an often deadly complication of infection in which systemic inflammation damages the vasculature, leading to tissue hypoperfusion and multiple organ failure. Currently, the standard of care for sepsis is predominantly supportive, with few therapeutic options available. Because of increased sepsis incidence worldwide, there is an urgent need for discovery of novel therapeutic targets and development of new treatments. The recently discovered function of the endoplasmic reticulum (ER) in regulation of inflammation offers a potential avenue for sepsis control. Here, we identify the ER-resident protein sigma-1 receptor (S1R) as an essential inhibitor of cytokine production in a preclinical model of septic shock. Mice lacking S1R succumb quickly to hypercytokinemia induced by a sublethal challenge in two models of acute inflammation. Mechanistically, we find that S1R restricts the endonuclease activity of the ER stress sensor IRE1 and cytokine expression but does not inhibit the classical inflammatory signaling pathways. These findings could have substantial clinical implications, as we further find that fluvoxamine, an antidepressant therapeutic with high affinity for S1R, protects mice from lethal septic shock and dampens the inflammatory response in human blood leukocytes. Our data reveal the contribution of S1R to the restraint of the inflammatory response and place S1R as a possible therapeutic target to treat bacterial-derived inflammatory pathology.

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Editorial III: Corticosteroids for septic shock—a standard of care?

British Journal of Anaesthesia ◽

10.1093/bja/aeh175 ◽

2004 ◽

Vol 93 (2) ◽

pp. 178-180 ◽

Cited By ~ 9

Author(s):

R. Bloomfield ◽

D.W. Noble

Keyword(s):

Septic Shock ◽

Standard Of Care

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Enhanced Performance of Next-Generation Sequencing Diagnostics Compared With Standard of Care Microbiological Diagnostics in Patients Suffering From Septic Shock

Critical Care Medicine ◽

10.1097/ccm.0000000000003658 ◽

2019 ◽

Vol 47 (5) ◽

pp. e394-e402 ◽

Cited By ~ 9

Author(s):

Silke Grumaz ◽

Christian Grumaz ◽

Yevhen Vainshtein ◽

Philip Stevens ◽

Karolina Glanz ◽

...

Keyword(s):

Septic Shock ◽

Next Generation Sequencing ◽

Standard Of Care ◽

Next Generation ◽

Microbiological Diagnostics ◽

Generation Sequencing

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Benefits of combination therapy of hydrocortisone, ascorbic acid and thiamine in sepsis and septic shock: A systematic review

Nutrition and Health ◽

10.1177/02601060211018371 ◽

2021 ◽

pp. 026010602110183

Author(s):

Young Ran Lee ◽

Kandace Vo ◽

Jincy Thazhampallatu Varughese

Keyword(s):

Septic Shock ◽

Ascorbic Acid ◽

Randomized Trials ◽

Standard Of Care ◽

Multiple Organs ◽

Risk Of Mortality ◽

Failure Assessment ◽

Sepsis And Septic Shock ◽

Vasopressor Use ◽

The Impact

Background: Sepsis and septic shock are severe medical conditions that can damage multiple organs with a higher risk of mortality. Recently, the combination of hydrocortisone, ascorbic acid and thiamine (HAT) was hypothesized to work synergistically to reverse septic shock and reduce mortality. Aim: To ascertain the efficacy of HAT therapy and compare whether HAT therapy is more beneficial compared to the standard of care in sepsis and septic shock patients. Methods: PubMed, Clinicaltrials.gov , Scopus, Web of Science, Cochrane and Embase are databases that were used to identify trials that conducted a study of the combination of HAT in sepsis or septic shock. Results: There were 134 articles identified through a database search and 16 from other sources, which were subsequently reduced to 11 trials (six randomized trials and five non-randomized trials) that were deemed appropriate for inclusion in this review. Most of the outcomes from these studies focused on mortality, the need for renal replacement therapy, duration of vasopressor use, changes in Sequential Organ Failure Assessment score, procalcitonin clearance and lengths of intensive care unit stay. Conclusion: Due to inconsistent results from clinical studies, the benefits of HAT therapy cannot be confirmed at this point in sepsis and septic shock. Currently, there are at least 20 randomized controlled trials testing HAT in various combinations and dosages in patients with severe sepsis and septic shock. The results of these studies are required before definitive conclusions can be made regarding the impact of this novel treatment strategy on the morbidity and mortality of patients with sepsis.

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