Refractory septic shock and alternative wordings: A systematic review of literature |
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| Affiliation: | 1. Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy;2. Department of Anesthesiology and Intensive Care, University Hospital of Modena, Modena, Italy;3. Intensive Care Unit, Trinity Centre for Health Science HRB-Wellcome Trust, St James''s Hospital, Dublin, Ireland.;4. Division of Pulmonary, Critical Care and Sleep Medicine and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA.;5. Critical Care Medicine, Central University of Venezuela. Anesthesia and Critical Care Medicine, Péterfy Sándor Hospital, Budapest, Hungary.;6. Intensive Care Department, Vall d''Hebron University Hospital, Shock, organ dysfunction and Resuscitation Research Group (SODIR), VHIR, Barcelona, Spain;7. Department of anesthesiology and intensive care unit, North Hospital, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France;1. Critical Care Department, Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina;2. Professor of Neurosciences and Neurosurgery- Universidad El Bosque – Bogota, Colombia;3. Medical and Research Director, MEDITECH Foundation, Cali, Colombia;4. Department of Neurosurgery and Critical Care, Santa Casa da Misericordia, Sao Joao del Rei, Minas Gerais, Brazil;5. Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy;6. Neurocritical Care, Departments of Neurology and Neurosurgery, University of Chicago Medical Center, Chicago, IL, USA;1. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia;2. Department of Intensive Care, Austin Hospital, Melbourne, Australia;3. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia;4. Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Australia;5. Department of Critical Care, University of Melbourne, Melbourne, Australia;1. University of Toronto, Toronto, Canada;2. Queen''s University, Kingston, Canada;3. McMaster University, Hamilton, Canada;4. Université Laval, Québec City, Canada;5. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;6. University of British Columbia, Vancouver, Canada;7. Université de Montréal, Montréal, Canada;8. University of Calgary, Calgary, Canada;9. McGill University, Montréal, Canada;10. Western University, London, Canada;11. University of Manitoba, Winnipeg, Canada;12. Université de Sherbrooke, Sherbrooke, Canada;13. University of Alberta, Edmonton, Canada;14. Dalhousie University, Halifax, Canada;1. Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland;2. First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland;3. International Fluid Academy, Lovenjoel, Belgium;4. Medical Data Management, Medaman, Geel, Belgium;1. Division of Intensive Care, Department of Anaesthesiology and Reanimation, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey;2. Department of Anaesthesiology and Reanimation, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey;1. Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy;2. Department of Neurological Sciences and Vision, Neurology Unit, ASST-Spedali Civili, Brescia, Italy |
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| Abstract: | BackgroundWe reviewed the different studies using the terms “refractory septic shock” and/or “catecholamine resistance” and/or “high dose norepinephrine” so as to highlight the heterogeneity of the definitions used by authors addressing such concepts.MethodA systematic review was conducted assessing the papers reporting data on refractory septic shock. We used keywords as exact phrases and subject headings according to database syntax.ResultsOf 276 papers initially reviewed, we included 8 studies – 3 randomized controlled trials, 3 prospective studies and 2 retrospective studies, representing a total of 562 patients with septic shock. Catecholamine resistance was generally defined as “a decreased vascular responsiveness to catecholamine independently of the administered norepinephrine dose”. Refractory septic shock was broadly defined as “a clinical condition characterized by persistent hyperdynamic shock even though adequate fluid resuscitation (individualized doses) and high doses of norepinephrine (≥ 1 μg/kg/min)”. Reported “high doses” of norepinephrine were often ≥1 μg/kg/min. However, wide variability was found throughout the literature on the use of these terms.DiscussionMarked inconsistencies were identified in the usage of the terms for refractory septic shock. There is a pressing need to determine consensus definitions so as to establish a common language in the medical literature and to harmonize future studies. |
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