Review
Medicine, General & Internal
Stephen Macdonald, Sandra L. Peake, Alasdair R. Corfield, Anthony Delaney
Summary: Intravenous fluid resuscitation is recommended as the first-line treatment for sepsis-associated hypotension and/or hypoperfusion, but there is limited high-level evidence to support this practice. Recent studies have found potential harms associated with large volume fluid resuscitation, leading to recommendations for a more conservative approach and earlier use of vasopressors. However, there is currently uncertainty and variation in practice regarding the choice between fluids or vasopressors for initial resuscitation in septic shock.
FRONTIERS IN MEDICINE
(2022)
Review
Critical Care Medicine
Jan Bakker, Eduardo Kattan, Djillali Annane, Ricardo Castro, Maurizio Cecconi, Daniel de Backer, Arnaldo Dubin, Laura Evans, Michelle Ng Gong, Olfa Hamzaoui, Can Ince, Bruno Levy, Xavier Monnet, Gustavo A. Ospina Tascon, Marlies Ostermann, Michal R. Pinsky, James A. Russell, Bernd Saugel, Thomas W. L. Scheeren, Jean-Louis Teboul, Antoine Vieillard Baron, Jean-Louis Vincent, Fernando G. Zampieri, Glenn Hernandez
Summary: Clinical and pathophysiological understanding of septic shock has advanced significantly in recent decades, leading to a gradual reduction in morbidity and mortality. While large randomized controlled trials have addressed key aspects of septic shock resuscitation, there are still many unanswered questions. This review focuses on current standards of septic shock resuscitation and evolving concepts, providing insights into potential research opportunities.
INTENSIVE CARE MEDICINE
(2022)
Article
Critical Care Medicine
Jay Chandra, Miguel A. Armengol de la Hoz, Gwendolyn Lee, Alexandria Lee, Patrick Thoral, Paul Elbers, Hyung-Chul Lee, John S. Munger, Leo Anthony Celi, David A. Kaufman
Summary: This study aims to quantify vascular leak in sepsis patients and guide fluid resuscitation.
Review
Medicine, General & Internal
Gianluca Tullo, Marcello Candelli, Irene Gasparrini, Sara Micci, Francesco Franceschi
Summary: Sepsis and septic shock are leading causes of in-hospital mortality worldwide, with significant burden on healthcare systems. Ultrasound has been used as an adjunctive tool for the diagnosis and treatment of these conditions, providing valuable information for clinicians. Further research is needed to determine the impact of ultrasound on patient survival.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Emergency Medicine
Hua-ling Wang, Jun Shao, Wei-li Liu, Fei Wu, Han-bing Chen, Rui-Qiang Zheng, Qi-hong Chen
Summary: A multicenter prospective observational study found that an initial fluid resuscitation rate of 20-30 ml/kg may be associated with reduced 28-day mortality in patients with septic shock, highlighting the need for further high-quality randomized controlled clinical trials to confirm these findings.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Letter
Medicine, General & Internal
Azib S. Shahid, Philip Fanapour, Raul J. Gazmuri
Summary: The CLASSIC trial found similar death rates at 90 days in patients with septic shock who received resuscitation with a restrictive-fluid strategy and a liberal-fluid approach.
NEW ENGLAND JOURNAL OF MEDICINE
(2022)
Review
Medicine, General & Internal
Shuaiyu Jiang, Mengmeng Wu, Xiaoguang Lu, Yilong Zhong, Xin Kang, Yi Song, Zhiwei Fan
Summary: This study indicates that limited fluid resuscitation (LFR) is more beneficial than harmful in patients with hemorrhagic shock or septic shock, reducing mortality, multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS), and disseminated intravascular coagulation (DIC) rates.
Article
Gastroenterology & Hepatology
Francois Durand, John A. Kellum, Mitra K. Nadim
Summary: Fluid resuscitation is complicated in patients with cirrhosis and hypotension due to circulatory changes and hyperdynamic state. Echocardiography shows promise for assessing fluid status. Large volumes of saline should be avoided in cirrhosis patients, and albumin may be superior for controlling inflammation. Vasopressors should be initiated early in cirrhosis patients with sepsis and hypotension, with norepinephrine as the first-line option.
JOURNAL OF HEPATOLOGY
(2023)
Review
Medicine, General & Internal
Anna S. Messmer, Tatjana Dill, Martin Muller, Carmen A. Pfortmueller
Summary: This study included 13 trials, and found that active fluid de-resuscitation measures had no significant impact on short-term mortality, fluid separation, or patient-centered outcomes in patients with septic shock. The current evidence is limited by the lack of high-quality trials, small sample sizes, and heterogeneity of de-resuscitation techniques.
EUROPEAN JOURNAL OF INTERNAL MEDICINE
(2023)
Article
Emergency Medicine
Gun Tak Lee, Sung Yeon Hwang, Jong Eun Park, Ik Joon Jo, Won Young Kim, Sung Phil Chung, You Hwan Jo, Gil Joon Suh, Sung-Hyuk Choi, Tae Gun Shin
Summary: The study aimed to investigate the diagnostic accuracy of post-fluid resuscitation lactate levels in predicting 28-day mortality in suspected septic shock patients. The results showed that post-fluid resuscitation lactate levels were more accurate than initial lactate levels in predicting mortality.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Article
Medicine, Research & Experimental
Yu-Ming Wang, Ying Chen, Yan-Jun Zheng, Yun-Chuan Huang, Wei-Wei Chen, Ran Ji, Li-Li Xu, Zhi-Tao Yang, Hui-Qiu Sheng, Hong-Ping Qu, En-Qiang Mao, Er-Zhen Chen
Summary: For patients with sepsis and septic shock, a low fluid intake volume during the first 24 h and a persistent negative fluid balance from the second day were found to be associated with favorable outcomes. The mean daily fluid balance was also identified as an independent prognostic factor for these patients.
EXPERIMENTAL AND THERAPEUTIC MEDICINE
(2021)
Article
Infectious Diseases
Pedro Martinez-Paz, Marta Aragon-Camino, Esther Gomez-Sanchez, Mario Lorenzo-Lopez, Estefania Gomez-Pesquera, Alejandra Fadrique-Fuentes, Pilar Liu, Alvaro Tamayo-Velasco, Christian Ortega-Loubon, Marta Martin-Fernandez, Hugo Gonzalo-Benito, Emilio Garcia-Moran, Maria Heredia-Rodriguez, Eduardo Tamayo
Summary: The study aims to distinguish between septic shock and non-septic shock in postoperative patients through gene expression signature, providing personalized treatment and avoiding unnecessary antibiotic use and increased healthcare costs.
JOURNAL OF INFECTION
(2021)
Article
Critical Care Medicine
Heekyung Lee, Sung-Hyuk Choi, Kyuseok Kim, Tae Gun Shin, Yoo Seok Park, Seung Mok Ryoo, Gil Joon Suh, Woon Yong Kwon, Tae Ho Lim, Donghee Son, Won Young Kim, Byuk Sung Ko
Summary: Initial fluid resuscitation of 30 mL/kg within 3 or 6 h was not significantly associated with in-hospital mortality in septic shock patients with isolated hyperlactatemia. However, administration of 30 mL/kg crystalloid within 6 h was associated with higher ICU admission and RRT.
JOURNAL OF CRITICAL CARE
(2021)
Review
Critical Care Medicine
Mahmoud A. Ammar, Abdalla A. Ammar, Patrick M. Wieruszewski, Brittany D. Bissell, Micah T. Long, Lauren Albert, Ashish K. Khanna, Gretchen L. Sacha
Summary: Septic shock is a healthcare concern associated with significant morbidity and mortality. Current guidelines recommend early fluid resuscitation and antimicrobials but do not provide clear recommendations on the appropriate time to initiate vasoactive therapies and corticosteroids. Recent studies have shown that early-high vasopressor initiation within the first 6 hours of shock onset is associated with lower mortality. The timing of initiating vasopressors and adjunctive therapies may be an important factor in improving outcomes.
ANNALS OF INTENSIVE CARE
(2022)
Article
Medicine, General & Internal
Maximilian Dietrich, Tobias Hoelle, Lazar Detelinov Lalev, Martin Loos, Felix Carl Fabian Schmitt, Mascha Onida Fiedler, Thilo Hackert, Daniel Christoph Richter, Markus Alexander Weigand, Dania Fischer
Summary: This study analyzed the indication for and effect of fresh frozen plasma (FFP) transfusion in patients with septic shock. The results showed that early FFP administration did not have significant harm or associated benefit in septic shock, and plasma should only be used in patients with a strong indication according to current recommendations.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Immunology
Jane Fisher, Fredrik Kahn, Elena Wiebe, Pontus Gustafsson, Thomas Kander, Lisa Mellhammar, Peter Bentzer, Adam Linder
Summary: The study revealed that in addition to neutrophils, monocytes can also release HBP, with the liver being responsible for the majority of its clearance. Further exploration is needed to understand the impact of hematologic malignancies and liver diseases on plasma HBP levels.
JOURNAL OF INNATE IMMUNITY
(2022)
Article
Public, Environmental & Occupational Health
Luigi Pisani, Anna Geke Algera, Ary Serpa Neto, Luciano Azevedo, Tai Pham, Frederique Paulus, Marcelo Gama de Abreu, Paolo Pelosi, Arjen M. Dondorp, Giacomo Bellani, John G. Laffey, Marcus J. Schultz
Summary: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in middle income countries (MICs) than in high-income countries (HICs), with a strong association with country-level economic status.
LANCET GLOBAL HEALTH
(2022)
Article
Critical Care Medicine
Manoj Maddali, Matthew Churpek, Tai Pham, Emanuele Rezoagli, Hanjing Zhuo, Wendi Zhao, June He, Kevin L. Delucchi, Chunxue Wang, Nancy Wickersham, J. Brennan McNeil, Alejandra Jauregui, Serena Ke, Kathryn Vessel, Antonio Gomez, Carolyn M. Hendrickson, Kirsten N. Kangelaris, Aartik Sarma, Aleksandra Leligdowicz, Kathleen D. Liu, Michael A. Matthay, Lorraine B. Ware, John G. Laffey, Giacomo Bellani, Carolyn S. Calfee, Pratik Sinha
Summary: Clinical classifier models based on machine learning can accurately assign ARDS subphenotypes, providing valuable prognostic information for patients and potentially guiding personalized treatment strategies in clinical practice.
LANCET RESPIRATORY MEDICINE
(2022)
Article
Oncology
Karolina Persson, Johanna Sjovall, Thomas Kander, Louise Walther- Sturesson
Summary: Continuous popliteal block significantly reduces postoperative extremity pain and opioid consumption in patients undergoing fibular graft harvesting for head and neck reconstructive surgery.
Article
Multidisciplinary Sciences
Hulda Thorarinsdottir, Thomas Kander, Dorota Johansson, Bo Nilsson, Bengt Klarin, Javier Sanchez
Summary: This study evaluated the blood compatibility of six commonly used CVCs and found that all tested catheters had an impact on blood cells, contact coagulation, the complement system, or inflammatory markers, although the impact varied. The polyurethane CVC coated with chlorohexidine and silver sulfadiazine had the most unfavorable blood compatibility profile, while the silicone dialysis catheter showed the greatest variation in blood compatibility.
SCIENTIFIC REPORTS
(2022)
Article
Anesthesiology
Ingrid Didriksson, Maerta Leffler, Martin Spangfors, Sarah Lindberg, Anton Reepalu, Anna Nilsson, Jonas Cronqvist, Sara Andertun, Maria Nelderup, Marten Jungner, Patrik Johnsson, Gisela Lilja, Attila Frigyesi, Hans Friberg
Summary: This comprehensive study investigated factors affecting mortality and functional outcomes in critically ill COVID-19 patients. The study found that age 60 and older and ICU burden were important factors associated with increased mortality. Additionally, smoking status, cortisone use, PaCO2 > 7 kPa, and inflammatory markers on admission were independent factors for 90-day mortality. A longer stay in the ICU was associated with unfavorable functional outcomes at 90 days.
ACTA ANAESTHESIOLOGICA SCANDINAVICA
(2023)
Article
Medicine, Research & Experimental
Ola Borgquist, Leila Naddi, Gracijela Bozovic, Matthias Hellberg, Martin Annborn, Fredrik Sjovall, Maria Adrian, Eva Hettinger, Pia Sjoberg, Thomas Kander
Summary: This study aims to compare the incidence of post-catheterisation central vein stenosis between the right subclavian and the right internal jugular routes for temporary central dialysis catheters (tCDC). The study will randomise patients to either subclavian or internal jugular vein catheterisation and evaluate different outcomes such as patients' discomfort and pain, dysfunction of the tCDC, catheterisation success rate, and mechanical complications. The accuracy of ultrasound examination in detecting central vein stenosis will also be evaluated.
Article
Medicine, General & Internal
Anja Linden, Jane Fisher, Gisela Lilja, Markus Harboe Olsen, Fredrik Sjovall, Marten Jungner, Martin Spangfors, Line Samuelsson, Jonatan Oras, Adam Linder, Johan Unden, T. Kander, Miklos Lipcsey, Niklas Nielsen, Janus C. Jakobsen, Peter Bentzer
Summary: This trial aims to test whether a protocol targeting non-resuscitation fluids can reduce fluid administration compared to usual care. The study design is a multicentre, randomised, feasibility trial, with adult ICU patients with septic shock as participants. The results will be submitted for publication in a peer-reviewed journal.
Article
Hematology
Lotta Sunnersjo, Henrik Lindstrom, Ulf Schott, Noa Tornquist, Thomas Kander
Summary: This study aimed to investigate the coefficient of variation (CV) for various coagulation parameters in blood samples with different coagulation states. The results showed that the CVs of clotting time (CT), alpha-angle, and maximum clot firmness (MCF) were higher in hypocoagulable samples compared to samples with normal coagulation, while clot formation time (CFT) showed no difference. These findings suggest that the interpretation of coagulation parameters in patients with weak coagulation should consider the limitation of CV.
THROMBOSIS JOURNAL
(2023)
Article
Public, Environmental & Occupational Health
Mika M. Rockholt, Tobis Agrell, Hulda Thorarinsdottir, Thomas Kander
Summary: This study investigated the incidence of catheter-related infections in southern Sweden and identified several risk factors. The results showed a low infection rate and indicated that catheters inserted through the subclavian route were less likely to be colonized by bacteria.
INFECTION PREVENTION IN PRACTICE
(2023)
Article
Critical Care Medicine
Carl Thomas Anthon, Frederic Pene, Anders Perner, Elie Azoulay, Kathryn Puxty, Andry van de Louw, Andreas Barratt-Due, Sanjay Chawla, Pedro Castro, Pedro Povoa, Luis Coelho, Victoria Metaxa, Matthias Kochanek, Tobias Liebregts, Thomas Kander, Johanna Hastbacka, Jo Bonding Andreasen, Edwige Peju, Lene Bjerregaard Nielsen, Christine Lodberg Hvas, Etienne Dufranc, Emmanuel Canet, Linda Lundqvist, Christopher John Wright, Julien Schmidt, Fabrice Uhel, Hafid Ait-Oufella, Mette Krag, Elisabet Cos Badia, Candido Diaz-Lagares, Sophie Menat, Guillaume Voiriot, Niels Erikstrup Clausen, Kristian Lorentzen, Reidar Kvale, Thomas Hildebrandt, Aleksander Rygh Holten, Kristian Strand, Asterios Tzalavras, Morten Heiberg Bestle, Pal Klepstad, Sara Fernandez, Damien Vimpere, Carolina Paulino, Carina Graca, Catherina Lueck, Christian Svendsen Juhl, Carolina Costa, Per Martin Badstolokken, Teresa Miranda, Lia Susana Aires Ledo, Joao Carlos Sousa Torres, Anders Granholm, Morten Hylander Moller, Lene Russell
Summary: Thrombocytopenia is common in ICU patients and is associated with worse outcomes, including increased mortality. In this study, 43.2% of ICU patients had thrombocytopenia, with 23.4% presenting at ICU admission and 19.8% developing it during their ICU stay. Prophylactic platelet transfusions were given to 22.6% of thrombocytopenic patients.
INTENSIVE CARE MEDICINE
(2023)
Article
Hematology
Sandra Jonmarker, Jacob Litorell, Felix Alarcon, Kais Al-Abani, Sofia Bjorkman, Maria Farm, Jonathan Grip, Marten Soderberg, Jacob Hollenberg, Rebecka Rubenson Wahlin, Thomas Kander, Liivi Rimling, Johan Martensson, Eva Joelsson-Alm, Martin Dahlberg, Maria Cronhjort
Summary: Measuring anti-Factor Xa activity may be relevant for administering low-molecular-weight heparin to patients with critical COVID-19. Lower peak values were associated with an increased risk of thromboembolism, while higher trough values were associated with an increased risk of death and bleeding.
THROMBOSIS JOURNAL
(2023)
Article
Critical Care Medicine
Theodor Sievert, Ingrid Didriksson, Martin Spangfors, Gisela Lilja, Kaj Blennow, Henrik Zetterberg, Attila Frigyesi, Hans Friberg
Summary: This study suggests that NfL, GFAP, and tau levels on ICU admission may serve as predictors of mortality and physical health-related quality of life in critically ill COVID-19 patients.
INTENSIVE CARE MEDICINE EXPERIMENTAL
(2023)
Review
Neurosciences
Emelie Andersson, Thomas Kander, Mads U. Werner, Joshua H. Cho, Eva Kosek, Martin F. Bjurstrom
Summary: Dysregulation of sleep is linked to heightened pain sensitivity and may contribute to chronic pain. Sleep-promoting pharmacotherapy shows potential in improving pain control.