Albumin Versus Gelatin Solution for the Treatment of Refractory Septic Shock: A Patient Baseline-Matched-Cohort Study

Objective: Although albumin solution is the colloid of choice to resuscitate septic shock patients who do not respond to crystalloid solutions, its usage is limited by its cost. Gelatin solution, is less expensive, but its efficacy has not yet been identified. This study aimed to compare the outcomes of gelatin and albumin solutions for septic shock resuscitation. Methods: This baseline-matched-cohort study, enrolled septic shock patients who had a mean arterial blood pressure (MAP) below 65 mmHg after receiving at least 30 mL per kilogram of crystalloid resuscitation fluid, and who required either an albumin or gelatin solution as fluid therapy. The primary outcome was the 28-day mortality. Results: In all, 224 patients who were administered either an albumin or gelatin solution were examined. After adjusting for differences in their baseline characteristics, 206 patients were included (104 receiving albumin, and 102 given gelatin). A comparison of the albumin and gelatin groups revealed no significant baseline differences in their respective mean APACHE II scores (22.8±8.5vs.23.2±8.1), MAPs (55.1±8.0vs.54.6±9.1mmHg), and lactate levels (5.6±4.7vs.6.3±4.9mmol/L). The 28-day mortality rates were 27.9% and 38.2% for the albumin and gelatin groups, respectively, with adjusted p=0.02. Moreover, the accumulation of fluid intake over output at 72 hours was significantly lower for the albumin than the gelatin group (5,964.5±4,959.7 vs. 8,133.2±3,743.2 ml; p=0.01). The RRT rate was higher for the albumin group (30.8% vs. 15.7%; p=0.01). Conclusion: Albumin resuscitation associated with lower 28-day mortality than gelatin resuscitation. The patients in the albumin group had a higher RRT rate and a lower fluid accumulation as at 72 hours

Terlipressin for refractory septic shock: a study protocol of a single center, placebo-controlled double-blind phase III RCT (The TERESEP study).

Introduction: In septic shock, vasopressin is a standard treatment that increases blood pressure by vasopressin receptor activation. Vasopressin can reduce catecholamine dose requirement and reduce cardiac arrhythmia in septic shock. Terlipressin is specific vasopressin 1 receptor that may replace vasopressin for septic shock treatment.The TERESEP trial evaluates the benefit of terlipressin add-on catecholamine versus catecholamine only treatment for septic shock. Methods and analysis: This single-center randomized controlled clinical trial is enrolling hospitalized intensive care patients with septic shock with norepinephrine doses of more than 0.2 microgram/kilogram/min or norepinephrine combine with epinephrine. Patient randomized for terlipressin combined with catecholamine or placebo combined with catecholamine. The primary endpoint is successful of shock treatment within 6 hours define as the rate of mean arterial blood pressure more than 65 mmHg achievement with catecholamine requirement dose less than 0.2 mcg/kg/min. The secondary outcomes include mean blood pressure, 28 days mortality, hospital mortality, intensive care unit range of stay, rate of urine output achievement, lactate clearance, accumulative catecholamine dose, cardiac arrhythmia, 28 days alive without any organ support. The main analysis will use intension to treat approach. Ethic and dissemination: The Ethics Committee has approved this study of Siriraj hospital, Mahidol University (COA No. SI 049/2020). The trial result will be disseminated through the presentation at medical publication. Authorship will consider and grant using the policy of Mahidol University. Trial registrations: ClinicalTrials.govNCT04339868. Registered on April 9,2020.</jats:p

Albumin Versus Gelatin Solution for the Treatment of Refractory Septic Shock: A Patient Baseline-Matched-Cohort Study

Objective: Although albumin solution is the colloid of choice to resuscitate septic shock patients who do not respond to crystalloid solutions, its usage is limited by its cost. Gelatin solution, is less expensive, but its efficacy has not yet been identified. This study aimed to compare the outcomes of gelatin and albumin solutions for septic shock resuscitation.Methods: This baseline-matched-cohort study, enrolled septic shock patients who had a mean arterial blood pressure (MAP) below 65 mmHg after receiving at least 30 mL per kilogram of crystalloid resuscitation fluid, and who required either an albumin or gelatin solution as fluid therapy. The primary outcome was the 28-day mortality.Results: In all, 224 patients who were administered either an albumin or gelatin solution were examined. After adjusting for differences in their baseline characteristics, 206 patients were included (104 receiving albumin, and 102 given gelatin). A comparison of the albumin and gelatin groups revealed no significant baseline differences in their respective mean APACHE II scores (22.8±8.5vs.23.2±8.1), MAPs (55.1±8.0vs.54.6±9.1mmHg), and lactate levels (5.6±4.7vs.6.3±4.9mmol/L). The 28-day mortality rates were 27.9% and 38.2% for the albumin and gelatin groups, respectively, with adjusted p=0.02. Moreover, the accumulation of fluid intake over output at 72 hours was significantly lower for the albumin than the gelatin group (5,964.5±4,959.7 vs. 8,133.2±3,743.2 ml; p=0.01). The RRT rate was higher for the albumin group (30.8% vs. 15.7%; p=0.01).Conclusion: Albumin resuscitation associated with lower 28-day mortality than gelatin resuscitation. The patients in the albumin group had a higher RRT rate and a lower fluid accumulation as at 72 hours.</jats:p