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Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review

Septic shock treatment remains a major challenge for intensive care units, despite the recent prominent advances in both management and outcomes. Vasopressors serve as a cornerstone of septic shock therapy, but there is still controversy over the timing of administration. Specifically, it remains un...

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Autores principales: Zhou, Hang-Xiang, Yang, Chun-Fu, Wang, He-Yan, Teng, Yin, He, Hang-Yong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515096/
https://www.ncbi.nlm.nih.gov/pubmed/37745258
http://dx.doi.org/10.5492/wjccm.v12.i4.204
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author Zhou, Hang-Xiang
Yang, Chun-Fu
Wang, He-Yan
Teng, Yin
He, Hang-Yong
author_facet Zhou, Hang-Xiang
Yang, Chun-Fu
Wang, He-Yan
Teng, Yin
He, Hang-Yong
author_sort Zhou, Hang-Xiang
collection PubMed
description Septic shock treatment remains a major challenge for intensive care units, despite the recent prominent advances in both management and outcomes. Vasopressors serve as a cornerstone of septic shock therapy, but there is still controversy over the timing of administration. Specifically, it remains unclear whether vasopressors should be used early in the course of treatment. Here, we provide a systematic review of the literature on the timing of vasopressor administration. Research was systematically identified through PubMed, Embase and Cochrane searching according to PRISMA guidelines. Fourteen studies met the eligibility criteria and were included in the review. The pathophysiological basis for early vasopressor use was classified, with the exploration on indications for the early administration of mono-vasopressors or their combination with vasopressin or angiotensinII. We found that mortality was 28.1%-47.7% in the early vasopressors group, and 33.6%-54.5% in the control group. We also investigated the issue of vasopressor responsiveness. Furthermore, we acknowledged the subsequent challenge of administration of high-dose norepinephrine via peripheral veins with early vasopressor use. Based on the literature review, we propose a possible protocol for the early initiation of vasopressors in septic shock resuscitation.
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spelling pubmed-105150962023-09-23 Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review Zhou, Hang-Xiang Yang, Chun-Fu Wang, He-Yan Teng, Yin He, Hang-Yong World J Crit Care Med Minireviews Septic shock treatment remains a major challenge for intensive care units, despite the recent prominent advances in both management and outcomes. Vasopressors serve as a cornerstone of septic shock therapy, but there is still controversy over the timing of administration. Specifically, it remains unclear whether vasopressors should be used early in the course of treatment. Here, we provide a systematic review of the literature on the timing of vasopressor administration. Research was systematically identified through PubMed, Embase and Cochrane searching according to PRISMA guidelines. Fourteen studies met the eligibility criteria and were included in the review. The pathophysiological basis for early vasopressor use was classified, with the exploration on indications for the early administration of mono-vasopressors or their combination with vasopressin or angiotensinII. We found that mortality was 28.1%-47.7% in the early vasopressors group, and 33.6%-54.5% in the control group. We also investigated the issue of vasopressor responsiveness. Furthermore, we acknowledged the subsequent challenge of administration of high-dose norepinephrine via peripheral veins with early vasopressor use. Based on the literature review, we propose a possible protocol for the early initiation of vasopressors in septic shock resuscitation. Baishideng Publishing Group Inc 2023-09-09 /pmc/articles/PMC10515096/ /pubmed/37745258 http://dx.doi.org/10.5492/wjccm.v12.i4.204 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Minireviews
Zhou, Hang-Xiang
Yang, Chun-Fu
Wang, He-Yan
Teng, Yin
He, Hang-Yong
Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review
title Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review
title_full Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review
title_fullStr Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review
title_full_unstemmed Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review
title_short Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review
title_sort should we initiate vasopressors earlier in patients with septic shock: a mini systemic review
topic Minireviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515096/
https://www.ncbi.nlm.nih.gov/pubmed/37745258
http://dx.doi.org/10.5492/wjccm.v12.i4.204
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