Imperial College London
Alternate

Emeritus ProfessorDerekBell

Faculty of Medicine, School of Public Health

Emeritus Professor in Acute Medicine
 
 
 
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Contact

 

+44 (0)7886 725 212d.bell

 
 
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Assistant

 

Miss Heather Barnes +44 (0)20 3315 8144

 
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Location

 

Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Citation

BibTex format

@article{Russell:2017:10.1097/CCM.0000000000002323,
author = {Russell, JA and Lee, T and Singer, J and Boyd, JH and Walley, KR and Vasopressin, and Septic Shock Trial VASST Group},
doi = {10.1097/CCM.0000000000002323},
journal = {Crit Care Med},
pages = {940--948},
title = {The Septic Shock 3.0 Definition and Trials: A Vasopressin and Septic Shock Trial Experience.},
url = {http://dx.doi.org/10.1097/CCM.0000000000002323},
volume = {45},
year = {2017}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - OBJECTIVES: The Septic Shock 3.0 definition could alter treatment comparisons in randomized controlled trials in septic shock. Our first hypothesis was that the vasopressin versus norepinephrine comparison and 28-day mortality of patients with Septic Shock 3.0 definition (lactate > 2 mmol/L) differ from vasopressin versus norepinephrine and mortality in Vasopressin and Septic Shock Trial. Our second hypothesis was that there are differences in plasma cytokine levels in Vasopressin and Septic Shock Trial for lactate less than or equal to 2 versus greater than 2 mmol/L. DESIGN: Retrospective analysis of randomized controlled trial. SETTING: Multicenter ICUs. METHODS: We compared vasopressin-to-norepinephrine group 28- and 90-day mortality in Vasopressin and Septic Shock Trial in lactate subgroups. We measured 39 cytokines to compare patients with lactate less than or equal to 2 versus greater than 2 mmol/L. PATIENTS: Patients with septic shock with lactate greater than 2 mmol/L or less than or equal to 2 mmol/L, randomized to vasopressin or norepinephrine. INTERVENTIONS: Concealed vasopressin (0.03 U/min.) or norepinephrine infusions. MEASUREMENTS AND MAIN RESULTS: The Septic Shock 3.0 definition would have decreased sample size by about half. The 28- and 90-day mortality rates were 10-12 % higher than the original Vasopressin and Septic Shock Trial mortality. There was a significantly (p = 0.028) lower mortality with vasopressin versus norepinephrine in lactate less than or equal to 2 mmol/L but no difference between treatment groups in lactate greater than 2 mmol/L. Nearly all cytokine levels were significantly higher in patients with lactate greater than 2 versus less than or equal to 2 mmol/L. CONCLUSIONS: The Septic Shock 3.0 definition decreased sample size by half and increased 28-day mortality rates by about 10%. Vasopressin lowered mortality versus norepinephrine if lactate was less than or equal to 2 mmol/L. Patients had higher plasma cytokines in lactate
AU  - Russell,JA
AU  - Lee,T
AU  - Singer,J
AU  - Boyd,JH
AU  - Walley,KR
AU  - Vasopressin,and Septic Shock Trial VASST Group
DO  - 10.1097/CCM.0000000000002323
EP  - 948
PY  - 2017///
SP  - 940
TI  - The Septic Shock 3.0 Definition and Trials: A Vasopressin and Septic Shock Trial Experience.
T2  - Crit Care Med
UR  - http://dx.doi.org/10.1097/CCM.0000000000002323
UR  - https://www.ncbi.nlm.nih.gov/pubmed/28333757
VL  - 45
ER  -
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