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Sepsis & Septic Shock
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https://www.nejm.org/doi/10.1056/NEJMoa2304748
In a trial, 661 patients with complicated UTI were randomized to receive cefepimeโtaniborbactam or meropenem. Of 436 in the microITT population, 70.6% on cefepimeโtaniborbactam vs. 58.0% on meropenem achieved composite success, showing superior efficacy (P=0.009). Safety profiles were similar.
In a systematic review and Bayesian network meta-analysis of 17 trials (7,688 patients), fludrocortisone plus hydrocortisone showed a lower risk of all-cause mortality in adult septic shock compared to hydrocortisone alone and placebo/usual care. The combination treatment had a 0.85 relative risk of mortality (moderate-certainty evidence) and was 12% more effective than hydrocortisone alone (low-certainty evidence). The analysis relied mainly on indirect evidence due to limited direct comparisons.
Do you add fludrocortisone to your septic shock patients requiring hydrocortisone?
Yes
No
The PROPHY-VAP study, a multicenter, randomized trial in eight French hospitals, evaluated the efficacy of a single dose of ceftriaxone in preventing early ventilator-associated pneumonia (VAP) in 319 mechanically ventilated, comatose patients with acute brain injury. Patients were assigned to either ceftriaxone or placebo groups. The study found a significant reduction in early VAP incidence in the ceftriaxone group (14%) compared to the placebo group (32%), with no adverse effects. This led to the recommendation of including ceftriaxone in VAP prevention protocols for such patients.
Ibrahim Ameen
30 janv.
This used single ceftriaxone dose 2g within 12 hours of intubation. It targets eliminating colonisation in orotracheal tree to decrease VAP incidence in pt with high risk for aspiration(stroke, TBI, ICH, SAH)
. It shows less early VAP,less ventilated days, fewer ICU days, less abx usage, fewer Hopitalisation days, delayed VAP onset in ceftriaxone arm, and only two pt showed ESBL in rectal swab upon discharge in ceftriaxonearm.
The microbiological showed majority of polymicrobial yield
They included GCS 3 - 12 (majority were 4 - 8)
Thanks for sharing, Dr. Mazen
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Nowadays There is a very important role for midodrine and fludrocortizone in sepsis to maintain SBP specifically to reverse vasoplegia caused by sepsis
Sometimes we cannot wean pressors
Patients be in very low doses for long time and when pressors omitted blood pressure dropped again
These patient respond very well to midodrine and fludrocortisone