Articles Tagged With: septic
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Vitamin C, Thiamine, and Steroids for Septic Shock — Still Unproven
Combination treatment with ascorbic acid (vitamin C), thiamine (vitamin B1), and corticosteroids does not improve clinical outcomes in adults with septic shock.
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Considerations and Concerns with Vitamin C in Sepsis and Septic Shock
Sepsis remains a major healthcare problem associated with significant morbidity and mortality. Roles for hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT therapy) as potential adjuvants remain controversial.
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ORANGES and ACTS Trials: No Mortality Benefit with Ascorbic Acid, Thiamine, and Hydrocortisone in Septic Shock Patients
Two double-blinded, placebo-controlled, randomized trials involving 337 patients (ORANGES, n = 137; ACTS, n = 200) with sepsis and septic shock have shown that administration of ascorbic acid, thiamine, and hydrocortisone did not reduce organ dysfunction or improve overall mortality. However, both trials showed that this combination therapy was effective in reducing the time to achieve shock resolution or shock-free days.
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Improving Sepsis Outcomes: Raising the Bar
In addition to compliance with the sepsis bundles, how can critical care providers revolutionize and individualize sepsis care for optimal results?
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Vitamin C, Thiamine, and Hydrocortisone for Septic Shock
The combination of vitamin C, thiamine, and hydrocortisone did not improve outcomes compared with hydrocortisone alone in patients with septic shock.
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Balanced Crystalloids Reduce Mortality in Critically Ill Adults With Sepsis or Septic Shock
Compared to saline, balanced crystalloids reduced in-hospital mortality and major adverse kidney events within 30 days in critically ill patients with sepsis or septic shock.
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Vasopressin Use in Septic Shock
Current management of septic shock includes early administration of intravenous fluids, antimicrobial agents, and vasopressor support. While norepinephrine is recommended as the first-line vasopressor for septic shock in the 2016 Surviving Sepsis Campaign guidelines, vasopressin is a second-line vasopressor option that may be added.
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Impact of Early Low-Dose Norepinephrine in Adults Experiencing Sepsis With Hypotension
Adult patients experiencing sepsis with hypotension but who did not meet the definition of septic shock received a median of 800 mL of intravenous fluid prior to initiation of norepinephrine 0.05 mcg/kg/min as a non-titratable infusion. Patients in this early vasopressor group had much lower odds of failing to achieve their primary outcome of adequate mean arterial pressure and tissue perfusion when early norepinephrine was provided.
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Corticosteroid Administration in Sepsis May Be Associated With Lower 28-Day Mortality
In this systematic review and meta-analysis of randomized, controlled trials comparing administration of corticosteroids with placebo or standard supportive care in sepsis, corticosteroids were associated with reduced 28-day mortality.
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Re-evaluating Steroid Therapy in Septic Shock
Two recent trials have provided more data regarding steroid therapy for septic shock.