Comment & Response February 13, 2018 Early Resuscitation for Adults With Sepsis in a Low-Income Country Wagner Luis Nedel, Caroline Deutschendorf JAMA. 2018;319(6):614. doi:10.1001/jama.2017.20406 To the Editor 致编辑 Dr Andrews and colleagues1 performed a randomized clinical trial of a sepsis protocol for early resuscitation involving intravenous fluids, vasopressors, and blood transfusion compared with usual care among adults with sepsis and hypotension in Zambi...

Comment & Response February 13, 2018 Early Resuscitation for Adults With Sepsis in a Low-income Country—Reply Matthew W. Semler, Ben Andrews, Gordon R. Bernard JAMA. 2018;319(6):614-615. doi:10.1001/jama.2017.20410 In Reply 回复 Drs Nedel and Deutschendorf highlight 2 key considerations for the interpretation of our trial and the management of patients with sepsis across settings: (1) timing of antibiotic administration and (2) volume of intravenous fluid. Nedel和D...

CC Nerd - The Case of the Relative Insufficiency January 20, 2018 by Rory Spiegel from https://emcrit.org/emnerd/cc-nerd-case-relative-insufficiency/ When it comes to the efficacy of glucocorticoid therapy for the treatment of septic shock, we have existed in a state of ambiguity, torn between the results of two contradictory RCTs. The first, the Annane et al trial published in JAMA in 2002, suggested a mortality benefit in favor of the corticosteroid group in the subset o...

The End of the ‘Roid? JC: ADRENAL Dan Horner | January 22, 2018 from http://stemlynsblog.org/the-end-of-the-roid-jc-adrenal/ So another year, another Critical Care Reviews meeting . Rob is doing an absolutely fantastic job with these, inviting lead authors from major critical care trials to present and defend their work. In fact, this is going so well that this year he appears to have convinced the editor of the NEJM to coincide publication of one of the most eagerly await...

Steroids in septic shock from http://www.thebottomline.org.uk/blog/steroids-in-sepsis/ We suggest against using IV hydrocortisone to treat septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability. If this is not achievable, we suggest IV hydrocortisone at a dose of 200 mg per day (weak recommendation, low quality of evidence). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Sept...

The Definitive Word on Steroids in Septic Shock Ryan Radecki / January 19, 2018 / Resuscitation, Sepsis, Vasopressors The Definitive Word on Steroids in Septic Shock As the authors say in their introduction, glucocorticoids have been in and out of favor as adjunctive treatment of patients in septic shock for over 40 years. Various trials have found results both favoring and discounting their utility – leading, finally, to this trial to end all trials: ADRENAL. Of course, ...

Recommended Reading from the Vrije Universiteit Amsterdam Medical Center Critical Care Medicine Fellows Mirjam Kop, Nicolas F. Schroten, Sharon Soe-Loek-Mooi, et al Am J Respir Crit Care Med Published on 18-October-2017 as 10.1164/rccm.201701-0245RR Keh D, et al. Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis. The HYPRESS randomized clinical trial. JAMA (1) Reviewed by Mirjam Kop Corticosteroids have been used for the treatment of patien...

Perspective > Critical Issues COMMENTARY The Pros and Cons of Extracorporeal Membrane Oxygenation for ARDS Aaron B. Holley, MD January 16, 2018 Using Extracorporeal Membrane Oxygenation for ARDS 采用ECMO治疗ARDS Critical Care Medicine just published a pro-con debate. One side argued for extracorporeal membrane oxygenation (ECMO) as first-line therapy for acute respiratory distress syndrome (ARDS); the other side argued against it.[1,2] I've spent the past 18 months w...

News > Reuters Health Information Steroid Therapy Speeds Recovery From Septic Shock, but With No Survival Benefit By Gene Emery January 22, 2018 (Reuters Health) - A hydrocortisone infusion does not reduce mortality among septic shock patients undergoing mechanical ventilation, but it does speed recovery when the condition is not fatal, according to an international study of 3,658 patients treated over four years. 根据一项历时4年入选了3658名患者的国际研究结果，接受...

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock Comment Kathrin Jähne, MD | Jan 25, 2018 Interesting but once again negative septic shock trial 有趣的但结果再次阴性的感染性休克试验 Steroid use in septic shock has multiple targets: Supplement the stress hormone cortisol to overcome TEMPORARY insufficiency. Faster reversal of shock may relate to this. Shock reversal is less likely to influence the primary end-point (90day mortality) and rather a very short te...