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HYPRESS Trial (2016): Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis

HYPRESS trial visual abstract

HYPRESS Trial Summary: Keh D, et al. randomized 380 patients with sepsis defined by ≥2 SIRS criteria, proven infection, and ≥1 organ with new dysfunction to either IV hydrocortisone or placebo. The objective was to assess if early hydrocortisone therapy reduces progression to septic shock compared to placebo in patients with severe sepsis. The results showed no difference in the development of septic shock in both groups P=0.70. The authors of HYPRESS trial concluded that among adults with severe sepsis not in septic shock, use of hydrocortisone compared with placebo did not reduce the risk of septic shock within 14 days.

Source: JAMA

BICAR-ICU: Sodium Bicarbonate in Severe Metabolic Acidaemia

 

2018, Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit, The Lancet

MERINO Trial: Piperacillin-Tazobactam vs Meropenem in ESBL infections

MERINO Trial of using pip tazo for patients with ESBL infection

MERINO Trial: 2018, Pip-Tazo vs Meropenem in patients with E-coli or Klebsiella infections,  JAMA

Earlier cohort studies yielded conflicting results when it comes to treating ceftriaxone-resistant E-coli and Klebsiella infections. Some studies reported noninferiority of piperacillin-tazobactam when compared to meropenem while others reported almost doubling of mortality.

In the MERINO trial, the patients were randomized to assess for non-inferiority of pip-tazo IV therapy versus IV meropenem. The results showed 12.3% 30-day mortality in the pip-tazo group compared to 3.7% with meropenem. Therefore, the study concluded that for E-coli and Klebsiella bloodstream infections, pip-tazo antibiotic is inferior to meropenem in terms of 30 days mortality.

TRISS Trial: Restrictive vs Liberal Transfusion in Septic Shock

triss trial visual abstract on blood transfusion in septic shock

The TRISS trial studied the role of transfusion thresholds in septic shock. 998 patients were divided into two transfusion groups. One group received Hb transfusion with goal Hb of > 7 while the other group received with the goal of Hb > 9. No difference in mortality or ischemic events were noted after a mean follow up period of 90 days. However, Patients with goal Hb > 7 received 50% less amount of transfusion compared to those with goal > 9.

Source

ALBIOS Trial: Albumin in Severe Sepsis & Septic Shock

2014, Does albumin infusion helps in Septic shock?, NEJM

APROCCHSS Trial: Hydrocortisone plus Fludrocortisone for Adults with Septic Shock

aprocchss trial visual abstract on hydrocortisone plus fludrocortisone in septic shock

The APROCCHSS trial clinically analyze the combination of steroid therapy in patients with septic shock and shows significant mortality benefit.

Source: NEJM

Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock

 

Source: CHEST

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