Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Septic Shock and Cardiovascular Dysfunction

BMC Infect Dis; ePub 2016 Oct 10; Brown, et al

Among patients with septic shock, only one-third of vasopressor up-titrations were successful, while mean arterial pressure (MAP) and the long-term fractal exponent were associated with success of up-titration, a recent study found. The complexity of heart rate variability was measured in 95 patients with septic shock requiring vasopressor in the 5 minutes before all vasopressor up-titrations and in the first 24 hours of an intensive care unit (ICU) admission. Researchers found:

  • Median number of up-titrations was 12.2 with a maximum of 49.
  • Median proportion of successful interventions was 0.28.
  • Median of MAP at the time of a vasopressor up-titration was 66 mm Hg.
  • On secondary analyses, the long-term fractal exponent was associated with success of up-titration.
  • Similarly, MAP was associated with success of vasopressor up-titration, independent of heart rate variability.


Brown SM, Sorensen J, Lanspa MJ, et al. Multi-complexity measures of heart rate variability and the effect of vasopressor titration: A prospective cohort study of patients with septic shock. [Published online ahead of print October 10, 2016]. BMC Infect Dis. doi:10.1186/s12879-016-1896-1.

This Week's Must Reads

Impact of Implementing ASPs in Small Hospitals, Clin Infect Dis; ePub 2018 Feb 23; Stenehjem, et al

HIV Diagnoses in Persons Aged 13-29 Years in US, MMWR; ePub 2018 Feb 23; Ocfemia, et al

Colonization as a Risk Factor for S. aureus, BMC Infect Dis; ePub 2018 Feb 21; Kim, et al

Mortality Estimates Among SARI Patients, BMC Infect Dis; ePub 2018 Feb 12; Barnes, et al

New IDSA/SHEA Clostridium Difficile Guidelines , Clin Infect Dis; ePub 2018 Feb 15; McDonald, et al

Must Reads in Mixed Topics

Kedrab Approved for Rabies Treatment, Kedrion news release; 2017 Aug 25

Septic Shock and Cardiovascular Dysfunction, BMC Infect Dis; ePub 2016 Oct 10; Brown, et al