Infectious Disease & Sepsis

Recently published in the journal of critical care medicine a systematic review and meta-analysis that aimed to determine whether targeting a higher mean arterial pressure (MAP) in adults with shock results in differences in important patient outcomes compared to a lower MAP.

The study used various data sources and the eligibility criteria included parallel-group randomized controlled trials in adult patients with a diagnosis of shock requiring vasoactive medications. The higher MAP group was required to receive vasoactive medications to target a higher MAP, whereas the lower MAP group received vasoactive medications to target a lower MAP.

Data from six randomized controlled trials were analyzed and showed that targeting a higher MAP (75–85 mm Hg) compared to a lower MAP of 65 mm Hg resulted in no difference in mortality (moderate certainty) but may reduce the risk of undergoing renal replacement therapy in patients with chronic hypertension. Further studies are needed to explor…

The results of the CLOVERS trial are now released at NEJM and revealed that 90-day mortality is not different between conservative fluid strategy with early vasopressor use and liberal fluid strategy with fluid-predominant approach. All patients had sepsis-induced hypotension refractory to the intravenous administration of at least 1000 ml of fluid (up to 3 liters). It is important to know that the study protocol excluded the following patients:

• Patients with an elapse of more than 4 hours since the meeting of the criteria.

• Patients with an elapse of more than 24 hours since presentation at the hospital.

• Previous receipt of more than 3000 ml of intravenous fluid during this episode (including prehospital administration of fluid by emergency medical services).

• Patients with the presence of fluid overload, and severe volume depletion from nonsepsis causes.

Thus the results cannot be generalized to any population other that those included in the study. However,

Combination therapy with colistin and meropenem was not superior to colistin monotherapy for the treatment of pneumonia or BSI caused by XDR A. baumannii, P. aeruginosa, or CRE in 464 patients who were enrolled in a randomized study published in NEJM evidence.

There was no difference in mortality (43% vs 37%), clinical failure (65% vs 58%), or microbiologic cure rates (65% vs 60%) between monotherapy and combination therapy groups respectively.

https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200131