RESUMEN

OBJECTIVE@#To investigate the effects of the pre-shock state on the mortality of patients with sepsis.@*METHODS@#We enrolled patients with sepsis admitted to the medical intensive care unit of a tertiary care university hospital. These patients were then classified into three groups: sepsis, pre-shock state, and septic shock. The primary outcome was the 28-day mortality rate. The secondary outcomes were the 90-day, 180-day, and 1-year mortality rates.@*RESULTS@#A total of 303 patients (groups: sepsis 135 [44.6%]), pre-shock state (93 [30.7%]), and septic shock (75 [24.8%]) completed the 1-year follow-up. The mortality rates at 28 days, 90 days, and 180 days and 1 year were significantly higher in the pre-shock state group than those of the sepsis group, but significantly lower than those in the septic shock group, especially among older patients. When compared with the pre-shock state group, the sepsis group had significantly lower mortality risks at 28 days, 90 days, and 180 days and 1 year, whereas the sepsis shock group had higher mortality risks at these time points.@*CONCLUSION@#The mortality rates of patients in the pre-shock state were notably different from those of patients with sepsis or septic shock. The introduction of a modified sepsis severity classification, which includes sepsis, pre-shock state, and septic shock, could offer valuable additional prognostic information.

Asunto(s)

RESUMEN

Patients at each shock stage may behave and present differently with a spectrum of shock severity and adverse outcomes. Shock severity, shock aetiology, and several factors should be integrated in management decision-making. Although the contemporary shock stages classification provided a standardized shock severity assessment, individual agents or management strategy has not yet been studied in the context of each shock stage. The pre-shock state may comprise a wide range of presentations. Nitrate therapy has potential benefit in myocardial infarction and acute heart failure. Herein, this review aims to discuss the potential use of nitrate therapy in the context of the pre-shock state or stage B of the contemporary shock classification given its various presentations.

RESUMEN

Objective: To investigate the effects of the pre-shock state on the mortality of patients with sepsis. Methods: We enrolled patients with sepsis admitted to the medical intensive care unit of a tertiary care university hospital. These patients were then classified into three groups: sepsis, pre-shock state, and septic shock. The primary outcome was the 28-day mortality rate. The secondary outcomes were the 90-day, 180-day, and 1-year mortality rates. Results: A total of 303 patients (groups: sepsis 135 [44.6%]), pre-shock state (93 [30.7%]), and septic shock (75 [24.8%]) completed the 1-year follow-up. The mortality rates at 28 days, 90 days, and 180 days and 1 year were significantly higher in the pre-shock state group than those of the sepsis group, but significantly lower than those in the septic shock group, especially among older patients. When compared with the pre-shock state group, the sepsis group had significantly lower mortality risks at 28 days, 90 days, and 180 days and 1 year, whereas the sepsis shock group had higher mortality risks at these time points. Conclusion: The mortality rates of patients in the pre-shock state were notably different from those of patients with sepsis or septic shock. The introduction of a modified sepsis severity classification, which includes sepsis, pre-shock state, and septic shock, could offer valuable additional prognostic information.

Asunto(s)

RESUMEN

OBJECTIVE: The aim of this study was to present new combination of algorithms for rhythm analysis during cardiopulmonary resuscitation (CPR) in automated external defibrillators (AED), called Analyze Whilst Compressing (AWC), designed for decreasing pre-shock pause and early stopping of chest compressions (CC) for treating refibrillation. METHODS: Two stages for AED rhythm analysis were presented, namely, "Standard Analysis Stage" (conventional shock-advisory analysis run over 5 s after CC interruption every two minutes) and "AWC Stage" (two-step sequential analysis process during CPR). AWC steps were run in presence of CC (Step1), and if shockable rhythm was detected then a reconfirmation step was run in absence of CC (Step2, analysis duration 5 s). RESULTS: In total 16,057 ECG strips from 2916 out-of-hospital cardiac arrest (OHCA) patients treated with AEDs (DEFIGARD TOUCH7, Schiller Médical, France) were subjected patient-wise to AWC training (8559 strips, 1604 patients) and validation (7498 strips, 1312 patients). Considering validation results, "Standard Analysis Stage" presented ventricular fibrillation (VF) sensitivity Se = 98.3% and non-shockable rhythm specificity Sp>99%; "AWC Stage" decision after Step2 reconfirmation achieved Se = 92.1%, Sp>99%. CONCLUSION: AWC presented similar performances to other AED algorithms during CPR, fulfilling performance goals recommended by standards. AWC provided advances in the challenge for improving CPR quality by: (i) not interrupting chest compressions for prevalent part of non-shockable rhythms (66-83%); (ii) minimizing pre-shock pause for 92.1% of VF patients. AWC required hands-off reconfirmation in 34.4% of cases. Reconfirmation was also common limitation of other reported algorithms (25.7-100%) although following different protocols for triggering chest compression resumption and shock delivery.

Asunto(s)

RESUMEN

PURPOSE: Automated external defibrillators (AED) prompt the rescuer to stop chest compressions (CC) for ECG analysis during out-of-hospital cardiac arrest (OHCA). We assessed the diagnostic accuracy and clinical benefit of a new AED algorithm (cprINSIGHT), which analyzes ECG and impedance signals during CC, allowing rhythm analysis with ongoing chest compressions. METHODS: Amsterdam Police and Fire Fighters used a conventional AED in 2016-2017 (control) and an AED with cprINSIGHT in 2018-2019 (intervention). In the intervention AED, cprINSIGHT was activated after the first (conventional) analysis. This algorithm classified the rhythm as "shockable" (S) and "non-shockable" (NS), or "pause needed". Sensitivity for S, specificity for NS with 90% lower confidence limit (LCL), chest compression fractions (CCF) and pre-shock pause were compared between control and intervention cases accounting for multiple observations per patient. RESULTS: Data from 465 control and 425 intervention cases were analyzed. cprINSIGHT reached a decision during CC in 70% of analyses. Sensitivity of the intervention AED was 96%, (LCL 93%) and specificity was 98% (LCL 97%), both not significantly different from control. Intervention cases had a shorter median pre-shock pause compared to control cases (8 s vs 22 s, p < 0.001) and higher median CCF (86% vs 80%, P < 0.001). CONCLUSION: AEDs with cprINSIGHT analyzed the ECG during chest compressions in 70% of analyses with 96% sensitivity and 98% specificity when it made a S or a NS decision. Compared to conventional AEDs, cprINSIGHT leads to a significantly shorter pre-shock pause and a significant increase in CCF.

Asunto(s)

RESUMEN

Antipsychotics have often been administered to treat delirium and intractable insomnia in elderly patients with or without dementia. However, antipsychotics sometimes cause severe adverse effects. We report two cases of very elderly patients who developed pre-shock after the administration of antipsychotics in a clinical consultation-liaison setting. These cases suggest that antipsychotics can induce fatal adverse events in very elderly patients. Although there has been little evidence regarding the most appropriate kind of drug and dosage for such patients, psychiatrists should exercise great caution in the use of antipsychotics for the very elderly, including deciding to prescribe the lowest dose or not prescribing them at all.

Asunto(s)