New approaches to treating septic shock
Thursday, March 22, 2018
With a mortality rate of about 50 percent, septic shock is the most common cause of death among critically ill patients in noncoronary intensive care units. Researchers continue to work toward creating better primary and adjunctive treatments to improve mortality rates.
Now two studies shed new light on the treatment of septic shock.
Using fludrocortisone and hydrocortisone together works
One large randomized study found that patients with septic shock receiving fludrocortisone and hydrocortisone together had improved survival rates compared to study participants who received placebos.
Researchers in that study, which spanned from 2008 to 2015, enrolled 1,241 patients experiencing septic shock for fewer than 24 hours. The participants in the test group received hydrocortisone 50 mg IV every six hours along with a daily dose of fludrocortisone 50 μg through a nasogastric tube for seven days. Participants in the control group received placebo for seven days.
Those receiving steroids had 43 percent mortality at 90 days, while those in the placebo group had a 49 percent mortality rate. The patients who received fludrocortisone and hydrocortisone also had two fewer days of organ failure or vasopressor use as compared to those in the control group.
Researchers in that study published their results this month in The New England Journal of Medicine
Hypothermia does not work
In the second study, researchers wanted to test the hypothesis that induced hypothermia could benefit patients with septic shock. Animal models of serious infection suggest that 24 hours of induced hypothermia could improve circulatory and respiratory function as well as reduce mortality.
Researchers in this study recruited patients from 10 ICUs in three countries in Europe and in North America. Inclusion criteria included mean arterial pressure of less than 70 mm Hg, and mechanical ventilation in an ICU with a predicted ICU stay of at least 24 hours. The participants were at least 50 years of age.
The participants in the study group underwent 24 hours of induced hypothermia with a target temperature of 32-34 degrees C, followed by 48 hours of normothermia with temperatures of 36-38 degrees C. Participants in the control group received routine thermal management.
The researchers screened 5,695 patients between Nov. 1, 2011, and Nov. 4, 2016. They had planned to recruit 560 participants to the trial, but terminated recruitment after only 436 after determining the trial was futile — 44.2 percent of the participants in the hypothermia group died within 30 days, compared with 35.8 percent of those in the routine thermal management group.
The results of the study suggest that induced hypothermia does not help, and it can be detrimental. Inducing hypothermia actually delayed the recovery of several vital organs. Compared with the patients receiving routine thermal management, those undergoing induced hypothermia had fewer days alive without mechanical ventilation, vasodilation therapy and renal replacement therapy within the first 30 days.
The scientists summed up their findings, published this month in The Lancet Respiratory Medicine, with a blunt statement: "Induced hypothermia should not be used in patients with septic shock."
Researchers continue to study septic shock, develop new treatments and phase out treatments that do not effectively reduce mortality rate.
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