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Short-term hemodynamic response to calcium supplementation in patients with refractory septic shock: a retrospective observational study

대한응급의학회지 2019년 30권 6호 p.529 ~ 536
장한솔 ( Chang Han-Sol ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine

황승연 ( Hwang Sung-Yeon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine
박종은 ( Park Jong-Eun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine
김태림 ( Kim Tae-Rim ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine
박주현 ( Park Joo-Hyun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine
윤희 ( Yoon Hee ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine
차원철 ( Cha Won-Chul ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine
심민섭 ( Sim Min-Seob ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine
조익준 ( Jo Ik-Joon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine
신태건 ( Shin Tae-Gun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine

Abstract


Objective: Research on calcium use as an adjunctive rescue therapy for refractory septic shock is limited. In this study, we aimed to investigate the short-term hemodynamic response after calcium supplementation in patients with refractory septic shock.

Method: This was a single-center, retrospective study of patients who presented to the Emergency Department from October 2014 through February 2018. Patients with refractory septic shock requiring norepinephrine-equivalent (NE) dose ≥ 0.5 μg/kg/min and receiving calcium supplementation, were included in the analysis. Patients were categorized into response group and no-response group, based on the changes in NE doses and mean arterial pressure after calcium administration. A multivariable logistic regression model was used to evaluate the association between hemodynamic response and 28-day survival.

Results: A total of 66 patients were included in the study. Of these, 34 patients (52%) were classified as the response group, and 32 patients (48%) encompassed the no-response group (17 patients who deteriorated and 15 patients who had no significant changes in the clinical status). The 28-day mortality was determined to be 44% in the response group and 63% in the no-response group (P=0.14). Multivariable analysis revealed that the response group had a significant association with lower 28-day mortality (adjusted odds ratio, 0.23; 95% confidence interval, 0.06-0.89; P=0.03).

Conclusion: Short-term hemodynamic changes after calcium administration were variable in patients with refractory septic shock. Hemodynamic improvement after calcium supplementation may be associated with better survival. Further studies are required to determine when calcium supplementation needs to be considered, and how it impacts patientcentered outcomes in refractory septic shock.

키워드

Calcium; Septic shock; Refractory shock; Vasopressor therapy; Hypotension
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