Additional Sepsis Management - References

References

• Avni, T. et al. Vasopressors for the treatment of septic shock: Systematic review and meta-analysis. PLoS One 2015.
• Evidence suggests a survival benefit, better hemodynamic profile and reduced adverse events rate for norepinephrine over dopamine. Norepinephrine should be regarded as the first line vasopressor in treatment of septic shock.
• Cardenas-Garcia, J. et al. Safety of Peripheral Intravenous Administration of Vasoactive Medication. J of Hosp Med 2015.
• Administration of norepinephrine, dopamine, or phenylephrine by peripheral intravenous access was feasible and safe in this single-center medical intensive care unit. Clinicians should not regard the use of vasoactive medication is an automatic indication for central venous access.
• De Backer, D. et al. Comparison of dopamine and norepinephrine in the treatment of shock.N Engl J Med 2010.
• The use of dopamine as first-line vasopressor agent was associated with a greater number of adverse events than the use of norepinephrine.
• Permpikul, C. et al. Early Use of Norepinephrine in Septic Shock Resuscitation(CENSER). A Randomized TrialAm J Respir Crit Care Med 2019.
• Early norepinephrine was significantly associated with increased shock control by 6 hours.

• Bosch, N. et al. Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs. Hydrocortisone Alone Among Patients With Septic Shock. JAMA 2023.
• Among patients with septic shock receiving norepinephrine who initiated hydrocortisone treatment, the addition of fludrocortisone was associated with lower rates of the composite of death or discharge to hospice compared with hydrocortisone alone.
• Fang, F. et al. Association of Corticosteroid Treatment with Outcomes in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis. JAMA IM 2019.
• This systematic review and meta-analysis of 37 randomized clinical trials suggests that administration of corticosteroid treatment in patients with sepsis is associated with significant improvement in health care outcomes and thus with reduced 28-day mortality.
• Rygård, S.L. et al. Low-dose corticosteroids for adult patients with septic shock: A systematic review with meta-analysis and trial sequential analysis. Intensive Care Med 2018.
• In adults with septic shock treated with low dose corticosteroids, short- and longer-term mortality are unaffected, adverse events increase, but duration of shock, mechanical ventilation and ICU stay are reduced.

• Bledsoe, J. et al. Order Substitutions and Education for Balanced Crystalloid Solution Use in an Integrated Health Care System and Association With Major Adverse Kidney EventsJAMA Network Open 2022.
• In this study, an implementation program in a large integrated health care system was associated with an increase in the proportion of balanced crystalloids received among patients in the emergency department and hospital settings and was associated with a reduction in major adverse kidney events.
• Brown, R.M. et al. Balanced Crystalloids versus Saline in Sepsis. A Secondary Analysis of the SMART Clinical TrialAm J Respir Crit Care Med 2019.
• Demonstrates that use of balanced crystalloids was associated with a lower 30-day in-hospital mortality compared with use of saline.
• Hammond, N.E. et al. Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-AnalysisNEJM Evid 2022. 
• The estimated effect of using balanced crystalloids versus saline in critically ill adults ranges from a 9% relative reduction to a 1% relative increase in the risk of death, with a high probability that the average effect of using balanced crystalloids is to reduce mortality.
• Jackson, K.E. et al. Effect of early balanced crystalloids before ICU admission on sepsis outcomes. Chest 2021.
• Among patients with sepsis, the effect of balanced crystalloids vs. saline on mortality was greater among patients for whom fluid choice was controlled starting in the ED compared with starting in the ICU.
• Rochwerg, B. et al. Fluid Resuscitation in Sepsis: A systematic review and network meta-analysis. Annals of Internal Medicine 2014
• Demonstrates that among patients with sepsis, resuscitation with balanced crystalloids or albumin compared with other fluids seems to be associated with reduced mortality.
• Vallée, M. et al. Compatibility of Lactated Ringer’s Injection With 94 Selected Intravenous Drugs During Simulated Y-site Administration. Hospital Pharmacy 2021.
• This study tested the compatibility of IV Lactated Ringer’s solution with 94 IV medications during simulated Y-site administration. Of the 94 tested drugs, 86 were found to be compatible with LR and 8 were found to be incompatible.
• Zampieri, F.G. et al. Association between Type of Fluid Received Prior to Enrollment, Type of Admission, and Effect of Balanced Crystalloid in Critically Ill Adults: A Secondary Exploratory Analysis of the BaSICS Clinical TrialAm J Respir Crit Care Med 2022.
• Demonstrates a high probability that balanced solution use in the ICU reduces 90-day mortality in patients who exclusively received balanced fluids before trial enrollment.

• Amoah, et al. Administration of a β-Lactam Prior to Vancomycin as the First Dose of Antibiotic Therapy Improves Survival in Patients with Bloodstream Infections. Clin Infec Dis 2022.
• Prioritizing administration of a β-lactam over vancomycin may reduce early mortality, underscoring the significant impact of a relatively simple practice change on improving patient survival.
• Strich, J.R. et al. Considerations for empiric antimicrobial therapy in sepsis and septic shock in an era of antimicrobial resistance. Journ Infect Dis 2020.
• Hospitals should have a performance improvement program to reduce the time from initial patient presentation to the administration of appropriate therapy for all patients who meet the screening definition of sepsis. An essential education element for nurses is the order of administration of antibiotics for sepsis. β-lactam antibiotics should be administered first before MRSA coverage given the broader spectrum activity and shorter infusion times for initial dosing.

• Angus, D. et al. Caring for Patients With Acute Respiratory Distress Syndrome: Summary of the 2023 ESICM Practice GuidelinesJAMA 2023.
• Summary of the 2023 ESICM Practice Guidelines.
• Neto, A.S. et al. Chapter 6 – Ventilatory Support of Patients with Sepsis or Septic Shock in Resource-Limited Settings.Sep Man Res Lim Set 2019.
• This chapter reviews recommendations on the identification of patients with ARDS, indications for mechanical ventilation, and strategies for lung-protective ventilation in resource-limited settings.
• Neto, A.S. et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: A meta-analysis. JAMA 2012.
• This analysis found evidence that a ventilation strategy using lower tidal volumes is associated with a lower risk for developing ARDS. Furthermore, the strategy was associated with lower mortality, fewer pulmonary infections, and less atelectasis when compared with higher tidal volume ventilation in patients without lung injury at the onset of ventilation.

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