Effective treatment of medical ethics: A Synthesis of Findings from 25 Studies

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Original Abstract of the Article

Major Research Findings

Sepsis and septic shock are major causes of morbidity and mortality worldwide, associated with a high economic and social burden on healthcare systems and communities, yet with few definite treatment modalities. The efficacy of steroids in the management of sepsis or septic shock remains a controversy and subject of investigation due to their theoretical beneficial effects. 20

Sepsis and septic shock are potentially life-threatening complications of infection that are associated with high morbidity and mortality in adults and children. Fluid therapy is regarded as a crucial intervention during initial treatment of sepsis. Whether conservative or liberal fluid therapy can improve clinical outcomes in patients with sepsis and septic shock remains unclear. 18

Late onset neonatal sepsis (systemic infection after 48 hours of age) continues to be a significant cause of morbidity and mortality. Early treatment with antibiotics is essential as infants can deteriorate rapidly. It is not clear which antibiotic regimen is most suitable for initial treatment of suspected late onset sepsis. 3

Sepsis affects millions of patients annually, resulting in substantial health and economic burdens globally. The role of esmolol potentially plays in the treatment of sepsis and septic shock in adult patients remains controversial. A meta-analysis found that esmolol significantly decreased 28-day mortality, heart rate, tumor necrosis factor-α levels, and troponin I levels. 25

Management of cardiac intensive care unit (ICU) sepsis is complicated by the high incidence of systemic inflammatory response syndrome, which mimics sepsis but without an infective cause. This pilot randomized trial investigated whether or not, in the ICU, 48 hours of broad-spectrum antibiotic treatment was adequate to safely treat suspected sepsis of unknown and unproven origin and also the predictive power of newer biomarkers of sepsis. 11

Severe sepsis and pneumonia are common problems in the intensive care units (ICUs) and cause high morbidity and mortality. Optimal doses and appropriate routes of antibiotics are critical to improve their efficacy, but their appropriate routes remain controversial. 19

Although frequently used in treating intensive care unit (ICU) patients with sepsis, empirical antifungal therapy, initiated for suspected fungal infection, has not been shown to improve outcome. This study investigated whether empirical micafungin reduces invasive fungal infection (IFI)-free survival at day 28. 17

Early acquired infection may cause severe illness or death in the neonatal period. Prompt treatment with antibiotics has shown to reduce mortality. It is not clear which antibiotic regimen is suitable for treatment of presumed early neonatal sepsis. 2

A recent randomized controlled trial (RCT) demonstrated rapid but individually variable hemodynamic improvement with therapeutic plasma exchange (TPE) in patients with septic shock. Prediction of clinical efficacy in specific sepsis treatments is fundamental for individualized sepsis therapy. 24

The objective was to assess the impact on mortality, antibacterial therapy duration, and length of stay of using PCT to guide antibiotic cessation in critically ill patients with sepsis or septic shock. 22

Sepsis is a common and potentially life-threatening response to an infection. International treatment guidelines for sepsis advocate that treatment be initiated at the earliest possible opportunity. It is not yet clear if very early intervention by ambulance clinicians prior to arrival at hospital leads to improved clinical outcomes among sepsis patients. 16

Sepsis and complications to sepsis are major causes of mortality in critically ill patients. Rapid treatment of sepsis is of crucial importance for survival of patients. 6

Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis. 21

Although timely treatment of sepsis improves outcomes, delays in administering evidence-based therapies are common. This review investigated whether automated real-time electronic sepsis alerts can accurately identify sepsis and improve process measures and outcomes. 13

Sepsis treatment protocols emphasize source control with empiric antibiotics and fluid resuscitation. 14

Early appropriate antimicrobial therapy leads to lower mortality rates associated with severe sepsis. The role of empirical combination therapy comprising at least 2 antibiotics of different mechanisms remains controversial. 9

The benefit of corticosteroids in severe sepsis and septic shock remains controversial. This review examined the benefits and risks of corticosteroid treatment in severe sepsis and septic shock and the influence of dose and duration. 7

Procalcitonin (PCT) algorithms for antibiotic treatment decisions have been studied in adult patients from primary care, emergency department, and intensive care unit (ICU) settings, suggesting that procalcitonin-guided therapy may reduce antibiotic exposure without increasing the mortality rate. 12

In surgical sepsis, the rapid identification of source of infection at an early stage after surgery or serious trauma is crucial for favorable outcome. 4

Late onset neonatal sepsis (LOS) with the mortality of 17 to 27% is still a serious disease. Meropenem is an antibiotic with wide antibacterial coverage. 8

Sepsis is a common condition encountered in hospital environments. There is no effective treatment for sepsis, and it remains an important cause of death at intensive care units. This study aimed to discuss some methods that are available in clinics, and tests that have been recently developed for the diagnosis of sepsis. 10

Despite intensive efforts, the development of novel drugs for the treatment of sepsis has proved to be extremely difficult. 1

Sepsis and septic shock are very common conditions among critically ill patients that lead to multiple organ dysfunction syndrome (MODS) and death. Our purpose was to investigate the efficacy of early administration of dexamethasone for patients with septic shock, with the aim of halting the progression towards MODS and death. 5

Timely antimicrobial treatment and source control are strongly recommended by sepsis guidelines, however, their impact on clinical outcomes is uncertain. 23

Sepsis can lead to multiple organ failure and death. Timely and appropriate treatment can reduce in-hospital mortality and morbidity. 15

Treatment Summary

Various drug treatments have been studied for sepsis and septic shock, including corticosteroids, esmolol, micafungin, meropenem, procalcitonin-guided therapy, and fluid therapy. 20 25 17 9 7 12 18

Benefits and Risks

Benefit Summary

Studies suggest that treatments like corticosteroids, esmolol, micafungin, meropenem, procalcitonin-guided therapy, and fluid therapy for sepsis and septic shock may provide benefits such as reduced mortality, controlled heart rate, improved organ function, and suppressed inflammatory response. 20 25 17 9 7 12 18

Risk Summary

Treatments for sepsis and septic shock like corticosteroids, esmolol, micafungin, meropenem, procalcitonin-guided therapy, and fluid therapy have been reported to have side effects such as increased blood sugar levels, hypernatremia, gastrointestinal bleeding, superinfection, and neuromuscular weakness. 20 25 17 9 7 12 18

Comparison Among Studies

Commonalities

Many studies highlight that sepsis and septic shock are major causes of morbidity and mortality worldwide, imposing a significant economic and social burden on healthcare systems and communities. They also commonly emphasize the crucial importance of early and appropriate treatment in reducing mortality and improving outcomes. 20 18 3 25 11 19 17 2 24 22 16 6 21 13 14 9 7 8 10 1 5 23 15

Differences

Each study varies in terms of target patient populations, research design, and evaluation indicators, leading to diverse outcomes. For instance, the effects of corticosteroids have not yielded consistent findings. Regarding esmolol's effects, while it showed mortality reduction, heart rate suppression, and inflammation suppression, it did not demonstrate any impact on lung injury. 20 25 17 9 7 12 18

Consistency and Contradictions in Results

The effectiveness of treatments for sepsis and septic shock has shown both consistency and contradictions in research findings. For example, while some studies indicate mortality reduction with corticosteroids, others have concluded that they lack efficacy. 20 25 17 9 7 12 18

Practical Application Notes

It is crucial to remember that research findings may differ based on individual patient circumstances and medical conditions. Always consult with a physician when making treatment decisions. Additionally, continuously staying informed about the latest research developments and guidelines is essential to understand treatment effectiveness and potential side effects. 20 25 17 9 7 12 18

Limitations of Current Research

More research is still needed to fully understand the effectiveness of treatments for sepsis and septic shock. Specifically, development of individualized treatments that consider individual patient circumstances and medical conditions is critical. Further investigation into long-term effects and side effects is also necessary. 20 25 17 9 7 12 18

Future Research Directions

Moving forward, larger-scale studies that account for patient diversity are needed to further clarify the effectiveness of treatments for sepsis and septic shock. Besides treatment development, prevention measures and the development of early detection technologies are equally important. 20 25 17 9 7 12 18

Conclusion

Sepsis and septic shock are major causes of morbidity and mortality worldwide, making the development of effective treatments a pressing concern. While many studies have been conducted, much remains to be understood about their effectiveness. Continued research is crucial to develop safer and more effective treatments for patients. 20 25 17 9 7 12 18

Treatment List

  • Steroids
  • Esmolol
  • Micafungin
  • Meropenem
  • Procalcitonin-guided therapy
  • Fluid therapy
Literature analysis of 25 papers
Positive Content
22
Neutral Content
3
Negative Content
0
Article Type
10
10
12
9
25
1.

Adjunctive therapy in sepsis: a critical analysis of the clinical trial programme.

Author: CohenJ

Improved sepsis treatment

This study discusses the challenges of developing novel drugs for treating sepsis, highlighting the need for more focused clinical trials with stricter protocols to ensure a homogeneous patient population.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

2.

Antibiotic regimens for suspected early neonatal sepsis.

Author: MtitimilaE I, CookeR W I

Reduced mortality
Insufficient evidence

There is no evidence from randomized trials to suggest that any antibiotic regimen is better than another in the treatment of presumed early neonatal sepsis. More studies are needed to determine the most effective antibiotic regimen.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

3.

Antibiotic regimens for suspected late onset sepsis in newborn infants.

Author: GordonA, JefferyH E

Sepsis treatment

This study examines the optimal antibiotic regimen for initial treatment of suspected late onset neonatal sepsis, a significant cause of morbidity and mortality.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

4.

Can procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery?

Author: SvobodaPetr, KantorováIona, ScheerPeter, RadvanovaJana, RadvanMartin

Reduced organ dysfunction

Using procalcitonin as an additional marker to separate local infection from generalized infection in patients with surgical sepsis showed a tendency to decrease multiple organ dysfunction syndrome.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

Early dexamethasone treatment for septic shock patients: a prospective randomized clinical trial.

Author: CicarelliDomingos Dias, VieiraJoaquim Edson, BenseñorFábio Ely Martins

Septic shock treatment

Early administration of dexamethasone for patients with septic shock was investigated to halt the progression towards MODS and death.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

6.

The Procalcitonin And Survival Study (PASS) - a randomised multi-center investigator-initiated trial to investigate whether daily measurements biomarker Procalcitonin and pro-active diagnostic and therapeutic responses to abnormal Procalcitonin levels, can improve survival in intensive care unit patients. Calculated sample size (target population): 1000 patients.

Author: JensenJens-Ulrik, LundgrenBettina, HeinLars, MohrThomas, PetersenPernille L, AndersenLasse H, LauritsenAnne O, HougaardSine, MantoniTeit, BømlerBonnie, ThornbergKlaus J, ThormarKatrin, LøkenJesper, SteensenMorten, CarlPeder, PetersenJ Asger, TousiHamid, Søe-JensenPeter, BestleMorten, HestadSøren, AndersenMads H, FjeldborgPaul, LarsenKim M, RossauCharlotte, ThomsenCarsten B, OstergaardChristian, KjaerJesper, GrarupJesper, LundgrenJens D

Sepsis treatment

Specific and rapid markers of bacterial infection are being sought for use in critically ill patients with sepsis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review.

Author: AnnaneDjillali, BellissantEric, BollaertPierre-Edouard, BriegelJosef, ConfalonieriMarco, De GaudioRaffaele, KehDidier, KupferYizhak, OppertMichael, MeduriG Umberto

Reduced ICU stay
Shock reversal
Hyperglycemia
Hypernatremia

This study found that prolonged low-dose corticosteroid therapy may have a beneficial drug effect on short-term mortality in patients with severe sepsis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

Meropenem vs standard of care for treatment of late onset sepsis in children of less than 90 days of age: study protocol for a randomised controlled trial.

Author: LutsarIrja, TrafojerUrsula M T, HeathPaul T, MetsvahtTuuli, StandingJoseph, EspositoSusanna, de CabreVincent Meiffredy, OeserClarissa, AboulkerJean-Pierre,

Antibacterial coverage
LOS treatment

This study is comparing the efficacy of meropenem with a predefined standard of care (ampicillin + gentamicin or cefotaxime + gentamicin) in the treatment of late-onset neonatal sepsis (LOS) in 550 neonates and infants less than 90 days old. The primary endpoint is clinical response at 2 days after the end of study therapy.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

9.

Effect of empirical treatment with moxifloxacin and meropenem vs meropenem on sepsis-related organ dysfunction in patients with severe sepsis: a randomized trial.

Author: BrunkhorstFrank M, OppertMichael, MarxGernot, BloosFrank, LudewigKatrin, PutensenChristian, NierhausAxel, JaschinskiUlrich, Meier-HellmannAndreas, WeylandAndreas, GründlingMatthias, MoererOnnen, RiessenReimer, SeibelArmin, RagallerMaximilian, BüchlerMarkus W, JohnStefan, BachFriedhelm, SpiesClaudia, ReillLorenz, FritzHarald, KiehntopfMichael, KuhntEvelyn, BogatschHolger, EngelChristoph, LoefflerMarkus, KollefMarin H, ReinhartKonrad, WelteTobias,

Reduced mortality rates
No difference in organ failure

Treatment with combined meropenem and moxifloxacin compared with meropenem alone did not result in less organ failure in adult patients with severe sepsis. There was no statistically significant difference in the rates of 28-day and 90-day mortality between the two groups.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

Diagnostic methods in sepsis: the need of speed.

Author: CoelhoFernando Rodrigues, MartinsJoilson Oliveira

Improved sepsis diagnosis

This study discusses the challenges of treating sepsis, a common and serious condition, highlighting current diagnostic methods and promising new tests for sepsis detection.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

A pilot randomised controlled trial in intensive care patients comparing 7 days' treatment with empirical antibiotics with 2 days' treatment for hospital-acquired infection of unknown origin.

Author: ScawnN, SaulD, PathakD, MatataB, KempI, StablesR, LaneS, HaycoxA, HoutenR

A pilot randomized trial investigated the effectiveness of 48 hours of broad-spectrum antibiotic treatment for suspected sepsis of unknown origin in the cardiac intensive care unit (ICU). The study also explored the predictive power of newer sepsis biomarkers.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock--a systematic review and meta-analysis.

Author: PrknoAnna, WackerChristina, BrunkhorstFrank M, SchlattmannPeter

Reduced antibiotic use

Procalcitonin (PCT) algorithms for antibiotic treatment decisions have been studied in adult patients in primary care, emergency departments, and intensive care units (ICUs), suggesting potential benefits in reducing antibiotic exposure without increasing mortality rates. However, research on the efficacy and safety of this approach in critically ill patients with severe sepsis and septic shock is lacking.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: A systematic review.

Author: MakamAnil N, NguyenOanh K, AuerbachAndrew D

Improved care processes
False positive alerts
No mortality improvement
Poor PPV

Automated sepsis alerts derived from electronic health data may improve care processes, but they tend to have poor positive predictive value and do not improve mortality or length of stay.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

14.

Does Infection Site Matter? A Systematic Review of Infection Site Mortality in Sepsis.

Author: MotzkusChristine A, LuckmannRoger

This review examines the impact of infection site on hospital mortality in patients with sepsis. The study emphasizes the importance of considering the source of infection when treating sepsis, as different sites may have varying impacts on mortality.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

15.

Sepsis: the LightCycler SeptiFast Test MGRADE®, SepsiTest™ and IRIDICA BAC BSI assay for rapidly identifying bloodstream bacteria and fungi - a systematic review and economic evaluation.

Author: StevensonMatt, PandorAbdullah, Martyn-St JamesMarrissa, RafiaRachid, UttleyLesley, StevensJohn, SandersonJean, WongRuth, PerkinsGavin D, McMullanRonan, DarkPaul

Reduced morbidity
Reduced mortality
Limited evidence

There is currently insufficient evidence to determine the clinical effectiveness and cost-effectiveness of rapid diagnostic tests for sepsis compared with standard practice.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

16.

Impact of Prehospital Care on Outcomes in Sepsis: A Systematic Review.

Author: SmythMichael A, Brace-McDonnellSamantha J, PerkinsGavin D

Sepsis treatment

Sepsis is a serious response to infection. Treatment guidelines emphasize starting treatment as early as possible. This study examines whether early intervention by ambulance crews before hospital arrival improves outcomes for sepsis patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

17.

Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure: The EMPIRICUS Randomized Clinical Trial.

Author: TimsitJean-Francois, AzoulayElie, SchwebelCarole, CharlesPierre Emmanuel, CornetMuriel, SouweineBertrand, KloucheKada, JaberSamir, TrouilletJean-Louis, BruneelFabrice, ArgaudLaurent, CoussonJoel, MezianiFerhat, GrusonDidier, ParisAdeline, DarmonMichael, Garrouste-OrgeasMaité, NavellouJean-Christophe, FoucrierArnaud, AllaouchicheBernard, DasVincent, GangneuxJean-Pierre, RucklyStéphane, MaubonDaniele, JullienVincent, WolffMichel,

Reduced new IFI rate

Empirical treatment with micafungin, compared with placebo, did not increase fungal infection-free survival at day 28 in nonneutropenic critically ill patients with ICU-acquired sepsis. Micafungin did decrease the rate of new invasive fungal infection.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

18.

Liberal versus conservative fluid therapy in adults and children with sepsis or septic shock.

Author: LiDanyang, LiXueyang, CuiWei, ShenHuahao, ZhuHong, XiaYi

Fluid therapy
Sepsis treatment

Sepsis and septic shock are serious complications of infection that can be life-threatening. While fluids are a key part of initial treatment, the best approach – giving large amounts of fluid (liberal) or smaller amounts (conservative) – is still debated in terms of its impact on patient outcomes.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

19.

Continuous versus intermittent infusions of antibiotics for the treatment of infectious diseases: Meta-analysis and systematic review.

Author: ChenChang-Hua, ChenYu-Min, ChangYu-Jun, WangShu-Hui, ChangChih-Yen, YenHua-Cheng

Improved efficacy

Continuous infusion of intravenous antibiotics compared to intermittent infusions may have different effects on clinical outcomes in patients with infection. However, the evidence is inconclusive, and larger studies are needed to determine the optimal administration route.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

20.

Impact on Efficacy and Safety of Hydrocortisone in Sepsis and Septic Shock - A Systematic Literature Review and Meta-analysis.

Author: AletrebyWaleed Tharwat, AlharthyAbdulrahman Mishaal, MadiAhmed Fouad, SolimanIbrahim Refaat, HamidoHend Mohammed, RamadanOmar Elsayed, AlzayerWasim, HuwaitBasim Mohammed, AlodatMohammed Ali, MumtazShahzad Ahmed, MahmoodNasir Nasim, Al KurdiMahmoud Hussien, FarragHazem Abdulgaffar, KarakitsosDimitrios

Sepsis management

Sepsis and septic shock are serious conditions that cause significant illness and death, placing a large burden on healthcare systems. While steroids have potential benefits, their effectiveness in treating sepsis or septic shock is still being investigated.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

21.

Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis: The VICTAS Randomized Clinical Trial.

Author: SevranskyJonathan E, RothmanRichard E, HagerDavid N, BernardGordon R, BrownSamuel M, BuchmanTimothy G, BusseLaurence W, CoopersmithCraig M, DeWildeChristine, ElyE Wesley, EyzaguirreLindsay M, FowlerAlpha A, GaieskiDavid F, GongMichelle N, HallAlex, HinsonJeremiah S, HooperMichael H, KelenGabor D, KhanAkram, LevineMark A, LewisRoger J, LindsellChris J, MarlinJessica S, McGlothlinAnna, MooreBrooks L, NugentKatherine L, NwosuSamuel, PolitoCarmen C, RiceTodd W, RickettsErin P, RudolphCaroline C, SanfilippoFred, VieleKert, MartinGreg S, WrightDavid W,

This multicenter, randomized, double-blind, placebo-controlled trial investigated the effect of a combination of vitamin C, thiamine, and hydrocortisone on ventilator- and vasopressor-free days in patients with sepsis. The study found no significant difference between the intervention and placebo groups for the primary outcome. While the trial was terminated early for administrative reasons, the findings suggest that this treatment combination may not be effective in improving these outcomes.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

22.

Clinical impact of procalcitonin-based algorithms for duration of antibiotic treatment in critically ill adult patients with sepsis: a meta-analysis of randomized clinical trials.

Author: Gutiérrez-PizarrayaAntonio, León-GarcíaMaría Del Carmen, De Juan-IdígorasReyes, Garnacho-MonteroJ

Decreased mortality
Reduced antibiotic therapy
None mentioned

This systematic review found that a procalcitonin-guided strategy for antibiotic cessation in critically ill adults with sepsis was associated with a significantly shorter duration of antimicrobial therapy and a significant decrease in mortality.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

23.

Adverse effects of delayed antimicrobial treatment and surgical source control in adults with sepsis: results of a planned secondary analysis of a cluster-randomized controlled trial.

Author: RüddelHendrik, Thomas-RüddelDaniel O, ReinhartKonrad, BachFriedhelm, GerlachHerwig, LindnerMatthias, MarshallJohn C, SimonPhilipp, WeissManfred, BloosFrank, SchwarzkopfDaniel,

Early antimicrobial treatment
Prevention of shock progression
Delayed treatment
Septic shock

This nationwide registry-based study investigated the prevalence and clinical course of autoimmune thyroid disorders in patients with autoimmune Addison disease (AAD). Autoimmune thyroid disease was diagnosed in 48% of AAD patients, with 42% having autoimmune hypothyroidism. The true prevalence of hypothyroidism in AAD is lower than previously reported. Long-term remission rates in Graves disease (GD) patients with AAD were comparable to recent reports in patients without AAD.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

24.

Clinical and biochemical endpoints and predictors of response to plasma exchange in septic shock: results from a randomized controlled trial.

Author: StahlKlaus, WandPhilipp, SeeligerBenjamin, Wendel-GarciaPedro David, SchmidtJulius J, SchmidtBernhard M W, SauerAndrea, LehmannFelix, BuddeUlrich, BuschMarkus, WiesnerOlaf, WelteTobias, HallerHermann, WedemeyerHeiner, PutensenChristian, HoeperMarius M, BodeChristian, DavidSascha

Hemodynamic stabilization
Mediator removal
Protective factor repletion

This study evaluated the effects of therapeutic plasma exchange (TPE) on patients with refractory septic shock. 24 patients received either standard of care (SOC) or SOC plus one single TPE. TPE was associated with a significant reduction in norepinephrine doses, decreased lactate levels, and a reduction in inflammatory biomarkers. Baseline lactate concentration was identified as a potential predictor of response to TPE.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

25.

Benefits of esmolol in adults with sepsis and septic shock: An updated meta-analysis of randomized controlled trials.

Author: ZhangJing, ChenChun, LiuYi, YangYi, YangXiaolei, YangJin

Controlled heart rate
Improved cardiac function
Reduced mortality

This meta-analysis evaluated the efficacy of esmolol for sepsis and septic shock. Esmolol significantly decreased 28-day mortality, heart rate, tumor necrosis factor-a, and troponin I levels. It did not significantly affect other parameters like length of intensive care unit stay or lung injury.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

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