Critical Care Alert – July 1, 2018
July 1, 2018
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Re-evaluating Steroid Therapy in Septic Shock
Septic shock carries a significant risk of mortality despite increasing knowledge of its pathophysiology and clinical management. Studies dating back to the 1960s suggested steroid treatment may alter the course of septic shock and led to the concept of critical illness-related corticosteroid insufficiency. Two recent trials have provided more data regarding steroid therapy for septic shock. Comparing these seminal studies provides context for the decision about whether to treat septic shock with steroid therapy.
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Selection of Isotonic Crystalloid for Fluid Resuscitation: How Much Does It Matter?
Using balanced crystalloids rather than normal saline for intravenous fluid administration in critically ill adults leads to statistically significant lower rates of major adverse kidney events, including death from any cause, new renal replacement therapy, and persistent renal dysfunction, compared to normal saline in critically ill adults. Clinical judgment should be applied when selecting fluid.
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Sepsis-related Neurologic Dysfunction Strongly Associated With Long-term Mortality
In this multicenter, retrospective study, acute neurologic dysfunction was the organ dysfunction most strongly associated with short- and long-term mortality in patients surviving a sepsis hospitalization.