-
ORIGINAL ARTICLE
Uncovering knowledge of pediatric sepsis and recognition of septic shock: a survey among Brazilian pediatricians
Critical Care Science. 2025;37:e20250143
02-28-2025
Abstract
ORIGINAL ARTICLEUncovering knowledge of pediatric sepsis and recognition of septic shock: a survey among Brazilian pediatricians
Critical Care Science. 2025;37:e20250143
02-28-2025DOI 10.62675/2965-2774.20250143
Views77See moreABSTRACT
Objective:
To evaluate the ability of Brazilian pediatricians to recognize sepsis and septic shock in children.
Methods:
A cross-sectional multicenter survey was conducted among Brazilian pediatricians between May and June 2023, before the release of the new Phoenix sepsis criteria in 2024. An online electronic system was used for surveys to characterize the knowledge and skills of physicians in the diagnosis and treatment of sepsis in children. The questions related to the diagnosis and treatment of sepsis and septic shock in children were based on the International Pediatric Sepsis Consensus Conference, the American College of Critical Care Medicine Guidelines, and the Surviving Sepsis Campaign in Pediatrics. Descriptive statistical analyses were performed using R software.
Results:
Pediatricians were surveyed about the recognition, knowledge, and management of pediatric patients with sepsis and septic shock. The responses of 355 physicians from all regions of Brazil were analyzed, with the majority from the southeastern region of the country (53.3%). In clinical practice, the most utilized criteria for diagnosing sepsis included inappropriate tachycardia (92%), temperature alteration (88.2%), and the presence of a suspected or confirmed infectious focus (87.9%). For septic shock, capillary refill time alteration (87.1%), arterial hypotension (84.8%), and changes in the level of consciousness (82.2%) were the predominant indicators. A total of 55.6% pediatricians reported having the potential to obtain venous or intraosseous access within 5 minutes, and 59.3% could administer antibiotics within the first hour. Approximately one-quarter (27.5%) of the participants responded that it was possible to infuse 40 - 60mL/kg in 1 hour. The most commonly used solution for fluid resuscitation was isotonic saline (70.9%), followed by Ringer's lactate (45.0%). The infusion of a vasopressor was considered in patients who did not improve after receiving an infusion of 40 - 60mL/kg (75.8%).
Conclusion:
This is the first study to assess the knowledge of sepsis and septic shock among the Brazilian pediatric population. The results reveal a significant deficiency in the recognition of sepsis. This study demonstrated a gap between evidence and clinical practice. Adherence to international guidelines needs to be improved.
Views77
Abstract
ORIGINAL ARTICLEUncovering knowledge of pediatric sepsis and recognition of septic shock: a survey among Brazilian pediatricians
Critical Care Science. 2025;37:e20250143
02-28-2025DOI 10.62675/2965-2774.20250143
Views77See moreABSTRACT
Objective:
To evaluate the ability of Brazilian pediatricians to recognize sepsis and septic shock in children.
Methods:
A cross-sectional multicenter survey was conducted among Brazilian pediatricians between May and June 2023, before the release of the new Phoenix sepsis criteria in 2024. An online electronic system was used for surveys to characterize the knowledge and skills of physicians in the diagnosis and treatment of sepsis in children. The questions related to the diagnosis and treatment of sepsis and septic shock in children were based on the International Pediatric Sepsis Consensus Conference, the American College of Critical Care Medicine Guidelines, and the Surviving Sepsis Campaign in Pediatrics. Descriptive statistical analyses were performed using R software.
Results:
Pediatricians were surveyed about the recognition, knowledge, and management of pediatric patients with sepsis and septic shock. The responses of 355 physicians from all regions of Brazil were analyzed, with the majority from the southeastern region of the country (53.3%). In clinical practice, the most utilized criteria for diagnosing sepsis included inappropriate tachycardia (92%), temperature alteration (88.2%), and the presence of a suspected or confirmed infectious focus (87.9%). For septic shock, capillary refill time alteration (87.1%), arterial hypotension (84.8%), and changes in the level of consciousness (82.2%) were the predominant indicators. A total of 55.6% pediatricians reported having the potential to obtain venous or intraosseous access within 5 minutes, and 59.3% could administer antibiotics within the first hour. Approximately one-quarter (27.5%) of the participants responded that it was possible to infuse 40 - 60mL/kg in 1 hour. The most commonly used solution for fluid resuscitation was isotonic saline (70.9%), followed by Ringer's lactate (45.0%). The infusion of a vasopressor was considered in patients who did not improve after receiving an infusion of 40 - 60mL/kg (75.8%).
Conclusion:
This is the first study to assess the knowledge of sepsis and septic shock among the Brazilian pediatric population. The results reveal a significant deficiency in the recognition of sepsis. This study demonstrated a gap between evidence and clinical practice. Adherence to international guidelines needs to be improved.
-
CLINICAL REPORT
Statistical analysis plan for hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: the ANDROMEDA-SHOCK-2 randomized clinical trial
- Nicolas Orozco
, - Gustavo García-Gallardo ,
- Alexandre Biasi Cavalcanti ,
- Tiago Mendonça dos Santos ,
- Gustavo Ospina-Tascón , [ ... ],
- Eduardo Kattan
01-15-2025
Abstract
CLINICAL REPORTStatistical analysis plan for hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: the ANDROMEDA-SHOCK-2 randomized clinical trial
Critical Care Science. 2025;37:e20250140
01-15-2025DOI 10.62675/2965-2774.20250140
- Nicolas Orozco ,
- Gustavo García-Gallardo ,
- Alexandre Biasi Cavalcanti ,
- Tiago Mendonça dos Santos ,
- Gustavo Ospina-Tascón ,
- Jan Bakker ,
- Sebastián Morales ,
- Karla Ramos ,
- Leyla Alegria ,
- Jean Louis Teboul ,
- Daniel De Backer ,
- Antoine Vieillard-Baron ,
- Liliana Vallecilla Fernandez ,
- Lucas Martins de Lima ,
- Lucas Petri Damiani ,
- Erica Ribeiro Sady ,
- Eliana Vieira Santucci ,
- Glenn Hernandez ,
- Eduardo Kattan
Views155See moreABSTRACT
Background
ANDROMEDA-SHOCK 2 is an international, multicenter, randomized controlled trial comparing hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock to standard care resuscitation to test the hypothesis that the former is associated with lower morbidity and mortality in terms of hierarchal analysis of outcomes.
Objective
To report the statistical plan for the ANDROMEDA--SHOCK 2 randomized clinical trial.
Methods
We briefly describe the trial design, patients, methods of randomization, interventions, outcomes, and sample size. We portray our planned statistical analysis for the hierarchical primary outcome using the stratified win ratio method, as well as the planned analysis for the secondary and tertiary outcomes. We also describe the subgroup and sensitivity analyses. Finally, we provide details for presenting our results, including mock tables, baseline characteristics, and the effects of treatments on outcomes.
Conclusion
According to best trial practices, we report our statistical analysis plan and data management plan prior to locking the database and initiating the analyses. We anticipate that this practice will prevent analysis bias and improve the utility of the study’s reported results.
Views155Abstract
CLINICAL REPORTStatistical analysis plan for hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: the ANDROMEDA-SHOCK-2 randomized clinical trial
Critical Care Science. 2025;37:e20250140
01-15-2025DOI 10.62675/2965-2774.20250140
- Nicolas Orozco ,
- Gustavo García-Gallardo ,
- Alexandre Biasi Cavalcanti ,
- Tiago Mendonça dos Santos ,
- Gustavo Ospina-Tascón ,
- Jan Bakker ,
- Sebastián Morales ,
- Karla Ramos ,
- Leyla Alegria ,
- Jean Louis Teboul ,
- Daniel De Backer ,
- Antoine Vieillard-Baron ,
- Liliana Vallecilla Fernandez ,
- Lucas Martins de Lima ,
- Lucas Petri Damiani ,
- Erica Ribeiro Sady ,
- Eliana Vieira Santucci ,
- Glenn Hernandez ,
- Eduardo Kattan
Views155See moreABSTRACT
Background
ANDROMEDA-SHOCK 2 is an international, multicenter, randomized controlled trial comparing hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock to standard care resuscitation to test the hypothesis that the former is associated with lower morbidity and mortality in terms of hierarchal analysis of outcomes.
Objective
To report the statistical plan for the ANDROMEDA--SHOCK 2 randomized clinical trial.
Methods
We briefly describe the trial design, patients, methods of randomization, interventions, outcomes, and sample size. We portray our planned statistical analysis for the hierarchical primary outcome using the stratified win ratio method, as well as the planned analysis for the secondary and tertiary outcomes. We also describe the subgroup and sensitivity analyses. Finally, we provide details for presenting our results, including mock tables, baseline characteristics, and the effects of treatments on outcomes.
Conclusion
According to best trial practices, we report our statistical analysis plan and data management plan prior to locking the database and initiating the analyses. We anticipate that this practice will prevent analysis bias and improve the utility of the study’s reported results.
- Nicolas Orozco
-
ORIGINAL ARTICLE
Lack of change in the respiratory quotient during oxygen supply dependence in endotoxemic shock: a subanalysis of an experimental controlled study
- Arnaldo Dubin ,
- Juan Francisco Caminos Eguillor ,
- Gonzalo Ferrara ,
- María Guillermina Buscetti ,
- Héctor Saúl Canales , [ ... ],
- Vanina Siham Kanoore Edul
12-22-2023
Abstract
ORIGINAL ARTICLELack of change in the respiratory quotient during oxygen supply dependence in endotoxemic shock: a subanalysis of an experimental controlled study
Critical Care Science. 2023;35(3):281-289
12-22-2023DOI 10.5935/2965-2774.20230041-en
- Arnaldo Dubin ,
- Juan Francisco Caminos Eguillor ,
- Gonzalo Ferrara ,
- María Guillermina Buscetti ,
- Héctor Saúl Canales ,
- Bernardo Lattanzio ,
- Luis Gatti ,
- Facundo Javier Gutierrez ,
- Vanina Siham Kanoore Edul
Views48See moreABSTRACT
Objective:
To evaluate if the reductions in systemic and renal oxygen consumption are associated with the development of evidence of anaerobic metabolism.
Methods:
This is a subanalysis of a previously published study. In anesthetized and mechanically ventilated sheep, we measured the respiratory quotient by indirect calorimetry and its systemic, renal, and intestinal surrogates (the ratios of the venous-arterial carbon dioxide pressure and content difference to the arterial-venous oxygen content difference. The Endotoxemic Shock Group (n = 12) was measured at baseline, after 60 minutes of endotoxemic shock, and after 60 and 120 minutes of fluid and norepinephrine resuscitation, and the values were compared with those of a Control Group (n = 12) without interventions.
Results:
Endotoxemic shock decreased systemic and renal oxygen consumption (6.3 [5.6 - 6.6] versus 7.4 [6.3 - 8.5] mL/minute/kg and 3.7 [3.3 - 4.5] versus 5.4 [4.6 - 9.4] mL/minute/100g; p < 0.05 for both). After 120 minutes of resuscitation, systemic oxygen consumption was normalized, but renal oxygen consumption remained decreased (6.3 [5.9 - 8.2] versus 7.1 [6.1 - 8.6] mL/minute/100g; p = not significance and 3.8 [1.9 - 4.8] versus 5.7 [4.5 - 7.1]; p < 0.05). The respiratory quotient and the systemic, renal and intestinal ratios of the venous-arterial carbon dioxide pressure and content difference to the arterial-venous oxygen content difference did not change throughout the experiments.
Conclusion:
In this experimental model of septic shock, oxygen supply dependence was not associated with increases in the respiratory quotient or its surrogates. Putative explanations for these findings are the absence of anaerobic metabolism or the poor sensitivity of these variables in detecting this condition.
Views48Abstract
ORIGINAL ARTICLELack of change in the respiratory quotient during oxygen supply dependence in endotoxemic shock: a subanalysis of an experimental controlled study
Critical Care Science. 2023;35(3):281-289
12-22-2023DOI 10.5935/2965-2774.20230041-en
- Arnaldo Dubin ,
- Juan Francisco Caminos Eguillor ,
- Gonzalo Ferrara ,
- María Guillermina Buscetti ,
- Héctor Saúl Canales ,
- Bernardo Lattanzio ,
- Luis Gatti ,
- Facundo Javier Gutierrez ,
- Vanina Siham Kanoore Edul
Views48See moreABSTRACT
Objective:
To evaluate if the reductions in systemic and renal oxygen consumption are associated with the development of evidence of anaerobic metabolism.
Methods:
This is a subanalysis of a previously published study. In anesthetized and mechanically ventilated sheep, we measured the respiratory quotient by indirect calorimetry and its systemic, renal, and intestinal surrogates (the ratios of the venous-arterial carbon dioxide pressure and content difference to the arterial-venous oxygen content difference. The Endotoxemic Shock Group (n = 12) was measured at baseline, after 60 minutes of endotoxemic shock, and after 60 and 120 minutes of fluid and norepinephrine resuscitation, and the values were compared with those of a Control Group (n = 12) without interventions.
Results:
Endotoxemic shock decreased systemic and renal oxygen consumption (6.3 [5.6 - 6.6] versus 7.4 [6.3 - 8.5] mL/minute/kg and 3.7 [3.3 - 4.5] versus 5.4 [4.6 - 9.4] mL/minute/100g; p < 0.05 for both). After 120 minutes of resuscitation, systemic oxygen consumption was normalized, but renal oxygen consumption remained decreased (6.3 [5.9 - 8.2] versus 7.1 [6.1 - 8.6] mL/minute/100g; p = not significance and 3.8 [1.9 - 4.8] versus 5.7 [4.5 - 7.1]; p < 0.05). The respiratory quotient and the systemic, renal and intestinal ratios of the venous-arterial carbon dioxide pressure and content difference to the arterial-venous oxygen content difference did not change throughout the experiments.
Conclusion:
In this experimental model of septic shock, oxygen supply dependence was not associated with increases in the respiratory quotient or its surrogates. Putative explanations for these findings are the absence of anaerobic metabolism or the poor sensitivity of these variables in detecting this condition.
- Arnaldo Dubin
-
REVIEW
Cytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis
- Jiovany Jhan Carlos Saldaña-Gastulo ,
- María del Rosario Llamas-Barbarán ,
- Lelis G. Coronel-Chucos ,
- Yamilée Hurtado-Roca
08-07-2023
Abstract
REVIEWCytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis
Critical Care Science. 2023;35(2):217-225
08-07-2023DOI 10.5935/2965-2774.20230289-en
- Jiovany Jhan Carlos Saldaña-Gastulo ,
- María del Rosario Llamas-Barbarán ,
- Lelis G. Coronel-Chucos ,
- Yamilée Hurtado-Roca
Views89See moreABSTRACT
Objective:
To analyze the effect of CytoSorb® on mortality, interleukin levels, vasopressor use and adverse events in patients with sepsis.
Methods:
We searched MEDLINE®, Embase and the Cochrane Library for randomized controlled trials and cohort studies that reported the use of CytoSorb® among septic patients. The primary outcome was mortality, and secondary outcomes included the use of vasopressors, levels of inflammatory markers, predicted versus observed mortality, length of stay in the intensive care unit, and adverse events.
Results:
We included 6 studies enrolling 413 patients, and assessment for risk of bias indicated variations in study quality from high to moderate. The overall mortality rate was 45%, and no significant effect on mortality was found at 28 - 30 days (RR 0.98 [0.12 - 8.25] for the randomized clinical trial and RR 0.74 [0.49 - 1.13] for cohort studies). We did not perform a metanalysis for other outcomes due to the small number of studies found or the lack of data.
Conclusion:
Our study found very low certainty evidence, due to imprecision, risk of bias, and heterogeneity, thereby showing no benefit of CytoSorb® use in terms of mortality at 28 - 30 days. We cannot recommend the use of CytoSorb® in septic or septic shock patients outside clinical trials. Further high-quality randomized trials with a common intervention arm are needed to evaluate the influence of CytoSorb® in this population.
PROSPERO register:
Views89Abstract
REVIEWCytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis
Critical Care Science. 2023;35(2):217-225
08-07-2023DOI 10.5935/2965-2774.20230289-en
- Jiovany Jhan Carlos Saldaña-Gastulo ,
- María del Rosario Llamas-Barbarán ,
- Lelis G. Coronel-Chucos ,
- Yamilée Hurtado-Roca
Views89See moreABSTRACT
Objective:
To analyze the effect of CytoSorb® on mortality, interleukin levels, vasopressor use and adverse events in patients with sepsis.
Methods:
We searched MEDLINE®, Embase and the Cochrane Library for randomized controlled trials and cohort studies that reported the use of CytoSorb® among septic patients. The primary outcome was mortality, and secondary outcomes included the use of vasopressors, levels of inflammatory markers, predicted versus observed mortality, length of stay in the intensive care unit, and adverse events.
Results:
We included 6 studies enrolling 413 patients, and assessment for risk of bias indicated variations in study quality from high to moderate. The overall mortality rate was 45%, and no significant effect on mortality was found at 28 - 30 days (RR 0.98 [0.12 - 8.25] for the randomized clinical trial and RR 0.74 [0.49 - 1.13] for cohort studies). We did not perform a metanalysis for other outcomes due to the small number of studies found or the lack of data.
Conclusion:
Our study found very low certainty evidence, due to imprecision, risk of bias, and heterogeneity, thereby showing no benefit of CytoSorb® use in terms of mortality at 28 - 30 days. We cannot recommend the use of CytoSorb® in septic or septic shock patients outside clinical trials. Further high-quality randomized trials with a common intervention arm are needed to evaluate the influence of CytoSorb® in this population.
PROSPERO register:
- Jiovany Jhan Carlos Saldaña-Gastulo
-
Review Article
Comparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande , [ ... ],
- Ariel Bardach
08-08-2022
Abstract
Review ArticleComparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
Revista Brasileira de Terapia Intensiva. 2022;34(2):279-286
08-08-2022DOI 10.5935/0103-507X.20220026-en
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande ,
- Luz Gibbons ,
- Federico Rodriguez Cairoli ,
- Ariel Bardach
Views36See moreABSTRACT
Objective:
The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate.
Methods:
We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate.
Results:
We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them.
Conclusion:
Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.
Views36Abstract
Review ArticleComparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
Revista Brasileira de Terapia Intensiva. 2022;34(2):279-286
08-08-2022DOI 10.5935/0103-507X.20220026-en
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande ,
- Luz Gibbons ,
- Federico Rodriguez Cairoli ,
- Ariel Bardach
Views36See moreABSTRACT
Objective:
The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate.
Methods:
We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate.
Results:
We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them.
Conclusion:
Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.
- Arnaldo Dubin
-
Special Article
Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
- Eduardo Kattan ,
- Jan Bakker ,
- Elisa Estenssoro ,
- Gustavo Adolfo Ospina-Tascón ,
- Alexandre Biasi Cavalcanti , [ ... ],
- Glenn Hernández
06-24-2022
Abstract
Special ArticleHemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
Revista Brasileira de Terapia Intensiva. 2022;34(1):96-106
06-24-2022DOI 10.5935/0103-507X.20220004-en
- Eduardo Kattan ,
- Jan Bakker ,
- Elisa Estenssoro ,
- Gustavo Adolfo Ospina-Tascón ,
- Alexandre Biasi Cavalcanti ,
- Daniel De Backer ,
- Antoine Vieillard-Baron ,
- Jean-Louis Teboul ,
- Ricardo Castro ,
- Glenn Hernández
Views112ABSTRACT
Background:
Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock.
Methods:
The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy.
Conclusions:
If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
Keywords:AlgorithmCapillary refill timecritical careEchocardiographyLength of staynorepinephrinePerfusionPhenotypesepsisseptic shockSee moreViews112Abstract
Special ArticleHemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
Revista Brasileira de Terapia Intensiva. 2022;34(1):96-106
06-24-2022DOI 10.5935/0103-507X.20220004-en
- Eduardo Kattan ,
- Jan Bakker ,
- Elisa Estenssoro ,
- Gustavo Adolfo Ospina-Tascón ,
- Alexandre Biasi Cavalcanti ,
- Daniel De Backer ,
- Antoine Vieillard-Baron ,
- Jean-Louis Teboul ,
- Ricardo Castro ,
- Glenn Hernández
Views112ABSTRACT
Background:
Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock.
Methods:
The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy.
Conclusions:
If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
Keywords:AlgorithmCapillary refill timecritical careEchocardiographyLength of staynorepinephrinePerfusionPhenotypesepsisseptic shockSee more
- Eduardo Kattan
-
ORIGINAL ARTICLE
Prevalence and outcomes of sepsis in children admitted to public and private hospitals in Latin America: a multicenter observational study
- Daniela Carla Souza ,
- Eliane Roseli Barreira,
- Huei Hsin Shieh,
- Andrea Maria Cordeiro Ventura,
- Albert Bousso, [ ... ],
- Eduardo Juan Troster
07-05-2021
Abstract
ORIGINAL ARTICLEPrevalence and outcomes of sepsis in children admitted to public and private hospitals in Latin America: a multicenter observational study
Revista Brasileira de Terapia Intensiva. 2021;33(2):231-242
07-05-2021DOI 10.5935/0103-507X.20210030
- Daniela Carla Souza ,
- Eliane Roseli Barreira,
- Huei Hsin Shieh,
- Andrea Maria Cordeiro Ventura,
- Albert Bousso,
- Eduardo Juan Troster
Views64ABSTRACT
Objective:
To report the prevalence and outcomes of sepsis in children admitted to public and private hospitals.
Methods:
Post hoc analysis of the Latin American Pediatric Sepsis Study (LAPSES) data, a cohort study that analyzed the prevalence and outcomes of sepsis in critically ill children with sepsis on admission at 21 pediatric intensive care units in five Latin American countries.
Results:
Of the 464 sepsis patients, 369 (79.5%) were admitted to public hospitals and 95 (20.5%) to private hospitals. Compared to those admitted to private hospitals, sepsis patients admitted to public hospitals did not differ in age, sex, immunization status, hospital length of stay or type of admission but had higher rates of septic shock, higher Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality 2 (PIM 2), and Pediatric Logistic Organ Dysfunction (PELOD) scores, and higher rates of underlying diseases and maternal illiteracy. The proportion of patients admitted from pediatric wards and sepsis-related mortality were higher in public hospitals. Multivariate analysis did not show any correlation between mortality and the type of hospital, but mortality was associated with greater severity on pediatric intensive care unit admission in patients from public hospitals.
Conclusion:
In this sample of critically ill children from five countries in Latin America, the prevalence of septic shock within the first 24 hours at admission and sepsis-related mortality were higher in public hospitals than in private hospitals. Higher sepsis-related mortality in children admitted to public pediatric intensive care units was associated with greater severity on pediatric intensive care unit admission but not with the type of hospital. New studies will be necessary to elucidate the causes of the higher prevalence and mortality of pediatric sepsis in public hospitals.
Keywords:childcritical illnessHospital, privateHospital, publicintensive care unitsIntensive care units, pediatricLatin Americamortalityprevalencesepsisseptic shockSee moreViews64Abstract
ORIGINAL ARTICLEPrevalence and outcomes of sepsis in children admitted to public and private hospitals in Latin America: a multicenter observational study
Revista Brasileira de Terapia Intensiva. 2021;33(2):231-242
07-05-2021DOI 10.5935/0103-507X.20210030
- Daniela Carla Souza ,
- Eliane Roseli Barreira,
- Huei Hsin Shieh,
- Andrea Maria Cordeiro Ventura,
- Albert Bousso,
- Eduardo Juan Troster
Views64ABSTRACT
Objective:
To report the prevalence and outcomes of sepsis in children admitted to public and private hospitals.
Methods:
Post hoc analysis of the Latin American Pediatric Sepsis Study (LAPSES) data, a cohort study that analyzed the prevalence and outcomes of sepsis in critically ill children with sepsis on admission at 21 pediatric intensive care units in five Latin American countries.
Results:
Of the 464 sepsis patients, 369 (79.5%) were admitted to public hospitals and 95 (20.5%) to private hospitals. Compared to those admitted to private hospitals, sepsis patients admitted to public hospitals did not differ in age, sex, immunization status, hospital length of stay or type of admission but had higher rates of septic shock, higher Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality 2 (PIM 2), and Pediatric Logistic Organ Dysfunction (PELOD) scores, and higher rates of underlying diseases and maternal illiteracy. The proportion of patients admitted from pediatric wards and sepsis-related mortality were higher in public hospitals. Multivariate analysis did not show any correlation between mortality and the type of hospital, but mortality was associated with greater severity on pediatric intensive care unit admission in patients from public hospitals.
Conclusion:
In this sample of critically ill children from five countries in Latin America, the prevalence of septic shock within the first 24 hours at admission and sepsis-related mortality were higher in public hospitals than in private hospitals. Higher sepsis-related mortality in children admitted to public pediatric intensive care units was associated with greater severity on pediatric intensive care unit admission but not with the type of hospital. New studies will be necessary to elucidate the causes of the higher prevalence and mortality of pediatric sepsis in public hospitals.
Keywords:childcritical illnessHospital, privateHospital, publicintensive care unitsIntensive care units, pediatricLatin Americamortalityprevalencesepsisseptic shockSee more
- Daniela Carla Souza
-
ORIGINAL ARTICLE
Time to clearance of abdominal septic focus and mortality in patients with sepsis
- Rafael Barberena Moraes ,
- Thiago Ferreira Serafini,
- Josi Vidart,
- Miriane Melo Silveira Moretti,
- Jaqueline Sangiogo Haas, [ ... ],
- Gilberto Friedman
06-24-2020
Abstract
ORIGINAL ARTICLETime to clearance of abdominal septic focus and mortality in patients with sepsis
Revista Brasileira de Terapia Intensiva. 2020;32(2):245-250
06-24-2020DOI 10.5935/0103-507X.20200029
- Rafael Barberena Moraes ,
- Thiago Ferreira Serafini,
- Josi Vidart,
- Miriane Melo Silveira Moretti,
- Jaqueline Sangiogo Haas,
- Alan Pagnoncelli,
- Marco Aurélio Abreu Azeredo,
- Gilberto Friedman
Views44See moreABSTRACT
Objective:
To assess the relationship between time to focus clearance and hospital mortality in patients with sepsis and septic shock.
Methods:
This was an observational, single-center study with a retrospective analysis of the time to clearance of abdominal septic focus. Patients were classified according to the time to focus clearance into an early (≤ 12 hours) or delayed (> 12 hours) group.
Results:
A total of 135 patients were evaluated. There was no association between time to focus clearance and hospital mortality (≤ 12 hours versus > 12 hours): 52.3% versus 52.9%, with p = 0.137.
Conclusion:
There was no difference in hospital mortality among patients with sepsis or septic shock who had an infectious focus evacuated before or after 12 hours after the diagnosis of sepsis.
Views44Abstract
ORIGINAL ARTICLETime to clearance of abdominal septic focus and mortality in patients with sepsis
Revista Brasileira de Terapia Intensiva. 2020;32(2):245-250
06-24-2020DOI 10.5935/0103-507X.20200029
- Rafael Barberena Moraes ,
- Thiago Ferreira Serafini,
- Josi Vidart,
- Miriane Melo Silveira Moretti,
- Jaqueline Sangiogo Haas,
- Alan Pagnoncelli,
- Marco Aurélio Abreu Azeredo,
- Gilberto Friedman
Views44See moreABSTRACT
Objective:
To assess the relationship between time to focus clearance and hospital mortality in patients with sepsis and septic shock.
Methods:
This was an observational, single-center study with a retrospective analysis of the time to clearance of abdominal septic focus. Patients were classified according to the time to focus clearance into an early (≤ 12 hours) or delayed (> 12 hours) group.
Results:
A total of 135 patients were evaluated. There was no association between time to focus clearance and hospital mortality (≤ 12 hours versus > 12 hours): 52.3% versus 52.9%, with p = 0.137.
Conclusion:
There was no difference in hospital mortality among patients with sepsis or septic shock who had an infectious focus evacuated before or after 12 hours after the diagnosis of sepsis.
- Rafael Barberena Moraes
septic shock Archives - Critical Care Science (CCS)
