Infectious Disease & Sepsis

Impact of Left Ventricular Systolic Function on Mortality in Sepsis and Septic Shock: A Retrospective Cohort Study

In this retrospective cohort study, the researchers aimed to investigate the association between left ventricular (LV) systolic function and in-hospital mortality in patients with sepsis and septic shock. They included all adult patients admitted to the medical ICU with sepsis or septic shock who underwent transthoracic echocardiography within 3 days of admission. The patients were divided into five groups based on LV ejection fraction (LVEF). The results revealed a U-shaped association between LVEF and in-hospital mortality, with both severely reduced LV systolic dysfunction (LVEF < 25%) and hyperdynamic LV (LVEF ≥ 70%) being independently associated with significantly higher mortality compared to the reference group (LVEF 55% to 70%). The study highlights the complexity of LV systolic function's impact on mortality in sepsis and septic shock, indicating the need for personalized resuscitation and vasopressor…

Contamination of Blood Cultures from Arterial Catheters and Peripheral Venipuncture in Critically Ill Patients

Blood cultures are crucial for detecting life-threatening bacteremia in critically ill patients. Contaminated blood cultures can lead to inappropriate antibiotic use, longer hospital stays, increased costs, and antimicrobial resistance risks. Strategies to reduce contamination include separate venipuncture sites or well-trained phlebotomy teams. In critically ill patients, using indwelling arterial catheters for blood culture collection is attractive due to reliable sampling and reduced invasiveness. Nakayama et al. conducted a multicenter trial comparing blood culture contamination rates between arterial catheters and peripheral venipuncture (0.3 vs 0.7%). The study found that obtaining cultures from arterial catheters is an acceptable alternative to venipuncture in critically ill adults with suspected bloodstream infections. More research is needed to consider other settings and patient groups.

Perspective:

The study by Nakayama et al. provides valuable insights into the use of arterial catheters as an…

Timing of Vasopressin Addition to Norepinephrine and Efficacy Outcomes in Patients With Septic Shock

1. 🏥 The trial examined the effect of the timing of vasopressin (AVP) addition to norepinephrine (NE) on septic shock patients' clinical outcomes, conducted retrospectively in a single health system over several sites from January 2018 to December 2019. 🕰️

2. 👥 The trial included 243 patients out of the initial 497, with patients being above 18, diagnosed with septic shock, and having received NE followed by AVP. Those with certain medical conditions or who were pregnant were excluded. 🚫

3. 🕑 Two groups were formed based on when AVP was added to NE treatment: an early group (within 3 hours) and a late group (after 3 hours). ⌛

4. 📊 Both groups had balanced characteristics at NE initiation. Still, differences were noticed in the SOFA score, weight, administration of hydrocortisone and vitamin C, and fluid dose prior to NE…

How Fast Should a Fluid Bolus be Given? (icureach.com)

1. 📚 A systematic review included 85 studies and 3601 patients, investigating the impact of rapid infusion rates (completed within 30 minutes) on stroke volume or cardiac output. It found a potential enhancement of these parameters due to effectively increased venous return and preload. 🔎✅🏥

2. 💧 Fluid volumes used in the review's trials varied: less than 500 mL in 12.7% of cases, 500 mL in 79.4%, and more than 500 mL in 7.9% of cases. 📏📊💧

3. 📈 Despite positive hemodynamic outcomes, the impact of rapid infusion rates on patient-centered outcomes remains uncertain, signaling a need for more research in this area. 🔄❔🚑

4. ⏱ A randomized controlled trial involving 10,520 critically ill patients compared infusion rates of 333 mL/hour (slower) vs. 999 mL/hour (faster). Mortality rates showed no significant difference between the groups, indicating that infusion rates don't dramatically impact survival. ☠️⚖️🕓

5. 💡…