Sepsis and septic shock: Guideline-based management

Article Figures & Data

TABLE 1

Randomized controlled trials of volume replacement in sepsis and septic shock

Author and year	Number of patients	Major findings
Finfer et al,⁴³ 2004	6,997	No reduction in mortality with albumin compared with saline
Perner et al,⁴⁷ 2012	804	Higher risk of death and renal replacement therapy with hydroxyethyl starch compared with Ringer solution
Annane et al,⁴⁵ 2013	2,587	No reduction in mortality, need for renal replacement therapy, duration of resuscitation, or length of stay with colloids compared with crystalloids
Caironi et al,⁴⁴ 2014	1,818	No reduction in mortality, need for renal replacement therapy, or length of stay with albumin replacement
Young et al,⁴¹ 2015	2,278	No difference in incidence of acute kidney injury, need for renal replacement therapy, or length of stay with balanced solution compared with saline
Semler et al,⁴⁰ 2018	15,802	Lower rates of mortality and need for renal replacement therapy with balanced solutions compared with saline

TABLE 2

Randomized controlled trials of vasopressors and inotropes in septic shock

Author and year	Number of patients	Major findings
Annane et al,⁶² 2007	330	No difference in mortality with epinephrine vs norepinephrine ± dobutamine; higher lactate elevation and lower pH in epinephrine group
Russell et al,⁵⁷ 2008	780	No reduction in mortality with addition of vasopressin to norepinephrine Survival benefit in patients with septic shock requiring norepinephrine < 15 μg/min Vasopressin had norepinephrine-sparing effect.
De Backer et al,⁵¹ 2010	1,679	Higher rates of mortality and arrhythmia with dopamine than with norepinephrine
Gordon et al,⁵⁶ 2016	409	No improvement in kidney failure-free days, use of renal replacement therapy, or mortality with vasopressin
Khanna et al,⁶⁰ 2017	344	Angiotensin II increased blood pressure in refractory vasodilatory shock

TABLE 3

Randomized controlled trials of corticosteroids in septic shock

Author and year	Number of patients	Major findings
Annane et al,⁶⁸ 2002	300	Lower mortality rate and shorter duration of shock in corticotropin nonresponders with hydrocortisone + fludrocortisone, but not in all patients
Sprung et al,⁶⁹ 2008	499	No difference in mortality rate, but shorter duration of shock and no increased risk of superinfection with hydrocortisone
Keh et al,⁷⁰ 2016	380	No benefit of hydrocortisone in preventing septic shock or decreasing mortality in severe sepsis
Annane et al,⁶⁶ 2018	1,241	Lower mortality rate and shorter duration of shock and mechanical ventilation with addition of hydrocortisone + fludrocortisone.
Venkatesh et al,⁶⁷ 2018	3,800	No reduction in mortality with addition of hydrocortisone, but reduced duration of shock, mechanical ventilation and length of stay in intensive care unit

TABLE 4

Randomized controlled trials evaluating early goal-directed care in septic shock

Author and year	Number of patients	Major findings
Rivers et al,⁶¹ 2001	268	Significantly lower mortality rate with protocolized care
Peake et al,⁸² 2014	1,600	No reduction in mortality, need for advanced respiratory or renal support, or intensive care unit length of stay with protocolized care
Rowan et al,⁸⁵ 2014	1,351	No reduction in mortality, need for advanced respiratory or renal support, or intensive care unit length of stay with protocolized care
Mouncey et al,⁸³ 2015	1,260	No reduction in mortality, need for advanced respiratory, cardiovascular or renal support, or intensive care unit length of stay with protocolized care