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HYPRESS Trial (2016): Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis
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.
2018, Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit, The Lancet
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.
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.
2014, Does albumin infusion helps in Septic shock?, NEJM
The APROCCHSS trial clinically analyze the combination of steroid therapy in patients with septic shock and shows significant mortality benefit.