Accéder au contenu principal

Early initiation of low-dose corticosteroid therapy in the management of septic shock: a retrospective observational study

Par

The use of low-dose steroid therapy in the management of septic shock has been extensively studied. However, the association between the timing of low-dose steroid therapy and the outcome has not been evaluated. Therefore, we evaluated whether early initiation of low-dose steroid therapy is associated with mortality in patients with septic shock.

Methods

We retrospectively analyzed the clinical data of 178 patients who received low-dose corticosteroid therapy for septic shock between January 2008 and December 2009. Time-dependent Cox regression models were used to adjust for potential confounding factors in the association between the time to initiation of low-dose corticosteroid therapy and in-hospital mortality.

Results

The study population consisted of 107 men and 71 women with a median age of 66 (interquartile range, 54-71) years. The 28-day mortality was 44% and low-dose corticosteroid therapy was initiated within a median of 8.5 (3.8-19.1) hours after onset of septic shock-related hypotension. Median time to initiation of low-dose corticosteroid therapy was significantly shorter in survivors than in non-survivors (6.5 hours vs. 10.4 hours; P = 0.0135). The mortality rates increased significantly with increasing quintiles of time to initiation of low-dose corticosteroid therapy (P = 0.0107 for trend). Other factors associated with 28-day mortality were higher Simplified Acute Physiology Score (SAPS) 3 (P < 0.0001) and Sequential Organ Failure Assessment (SOFA) scores (P = 0.0007), dose of vasopressor at the time of initiation of low-dose corticosteroid therapy (P < 0.0001), need for mechanical ventilation (P = 0.0001) and renal replacement therapy (P < 0.0001), while the impaired adrenal reserve did not affect 28-day mortality (81% vs. 82%; P = 0.8679). After adjusting for potential confounding factors, the time to initiation of low-dose corticosteroid therapy was still significantly associated with in-hospital mortality (adjusted OR 1.025, 95% CI 1.007-1.044, P = 0.0075). The early therapy group (administered within 6 hours after the onset of septic shock, n = 66) had a 37% lower mortality rate than the late therapy group (administered after 6 hours after the onset of septic shock, n = 112) (32% vs. 51%, P = 0.0132).

Conclusions

Early initiation of low-dose corticosteroid therapy was significantly associated with decreased mortality.

Commentaires

Enregistrer un commentaire

Posts les plus consultés de ce blog

The Muse Brooklyn

Par
http://abcirque.com http://www.amny.com/things-to-do/circus-class-at-the-muse-brooklyn-teaches-acrobatic-skills-1.13781898 https://www.instagram.com/p/Bx-D67pAxGz/ https://www.instagram.com/p/Bx7e3GFgpp2/ https://www.instagram.com/p/Bx5xpoPn_hm/ https://www.instagram.com/p/Bx40FSvj2Tf/ https://www.instagram.com/p/Bx0p224DkxE/ https://www.instagram.com/p/BxzxjhqFO1S/ https://www.instagram.com/p/BxyJmIaAeSd/ https://www.instagram.com/p/BxxweSaF6q4/ https://www.instagram.com/p/BxxSsdcAjFg/ https://www.instagram.com/p/Bxvr0SSgpPs/ https://new.mta.info/L-Project http://themusegowanus.com http://instagram.com/themusebrooklyn https://www.facebook.com/TheMuseBrooklyn/ https://twitter.com/TheMuseBrooklyn https://www.youtube.com/channel/UCkzh62AIfOI7XU3I0P6rWIQ
Enregistrer un commentaire
Lire la suite

Fw:

Par
Consider this message as your last warning. We hacked your system! We have copied all the data from your device to our own servers. Curious videos were recorded from your camera and your actions while watching porn. Your device was infected with our virus when you visited the porn site. The Trojan virus gives us full access, allows us to control your device. The virus allows not only to see your screen, but also to turn on your camera, microphone, without your knowledge. We took over the video from your screen and camera, then we mounted a video in which you can see you watching porn in one part of the screen and masturbating in the other. But that’s not all! We have access to all the contacts in your phone book and social networks. It won’t take us long to send this video to your friends, family and friends on social networks, messengers and email in minutes. We have a lot of audio recordings of your personal conversations, where a lot of “intere...
Enregistrer un commentaire
Lire la suite

Systemic Lidocaine Decreased the Perioperative Opioid Analgesic Requirements but Failed to Reduce Discharge Time After Ambulatory Surgery

Par
Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge. Postoperative pain is the most common reason for delay in discharge and unplanned hospital admission after ambulatory surgery. 1–3 Because postoperative pain is to a large extent an inflammatory phenomenon, administration of systemic local anesthetics, which have inflammatory modulatory properties, 4 could significantly reduce pain and therefore allow more rapid discharge. 5 Lidocaine has an excellent safety record when administered by low-dose infusion. 5–7 However, whereas decreased hospital stay after inpatient surgery has been demonstrated, the effect of intraoperative and early postoperative lidocaine infusion on duration of stay after ambulatory surgery is not known. Although it see...
Enregistrer un commentaire
Lire la suite