Most Read Articles
Roshini Claire Anthony, 4 days ago

The combined use of piperacillin and tazobactam does not appear to be a suitable alternative to meropenem for patients with bloodstream infections caused by ceftriaxone-resistant Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae), according to results of the MERINO* trial.

Tristan Manalac, 19 May 2018
Taking oral antibiotics appears to increase the risk of nephrolithiasis, according to a recent study. Moreover, the risk seems to be compounded for individuals with recent antibiotic exposure and those who were exposed at a younger age.
2 days ago
Patients with inflammatory bowel disease are at increased risk of developing acute myocardial infarction (AMI) or heart failure, although the prevalence of traditional risk factors for such cardiovascular disorders appears to be low, as reported in a recent study.
3 days ago
Early renin-angiotensin-aldosterone system (RAAS) blockade with renin-angiotensin system inhibitors (RASI) leads to better short- and long-term renal outcomes in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN), according to a study, adding that this renal protective effect is independent of RASI’s antihypertensive and antiproteinuric effects.

Selepressin shows promise in septic shock management

Audrey Abella
30 Aug 2017

The novel V1A-selective vasopressin receptor agonist selepressin may be an effective substitute for the traditional vasopressor norepinephrine in patients in early septic shock, a recent study has found.

In this double-blind multicentre trial, 53 patients in early septic shock were randomized to receive one of three ascending infusion rates of selepressin (1.25 ng/kg/min [n=10], 2.5 ng/kg/min [n=19], or 3.75 ng/kg/min [n=2]) or placebo (n=21) until shock resolution or a maximum 7 days.

At 24 hours, more patients given 2.5 ng/kg/min selepressin (about 70 percent) maintained a mean arterial pressure (MAP) of >60 mmHg without norepinephrine compared with those on 1.25 ng/kg/min selepressin (<20 percent) and placebo (20 percent).

Compared with placebo, use of selepressin 2.5 ng/kg/min resulted in the rapid reduction of norepinephrine mean infusion rate (0.04 vs 0.18 μg/kg/min at 24 hours), reduction of cumulative net fluid balance from day 5 onwards (p<0.05), and a higher proportion of days alive and free of ventilation (54 percent vs. 23 percent; p<0.02). [Crit Care 2017;doi:10.1186/s13054-017-1798-7]

“[A]t an infusion rate of 2.5 ng/kg/minute, [selepressin] rapidly replaced norepinephrine while maintaining target MAP and may have improved fluid balance and shortened the time of mechanical ventilation,” said the researchers.

“Reducing the dose of norepinephrinecould in itself be advantageous because it could decrease the adverse effects of norepinephrine … [and] have beneficial effects on fluid balance and vascular leak,” they said.

The greater proportion of patients weaned off norepinephrine during the first 24 hours and the decreased mean cumulative norepinephrine dose demonstrate rapid onset and sustained activity, suggesting selepressin to be a potent vasopressor, noted the researchers.

Furthermore, the reduced mechanical ventilation period reflects selepressin’s potential in mitigating the risks associated with long periods of mechanical ventilation such as nosocomial pneumonia, neuromuscular weakness, and mortality, they added.

As this was the first inpatient trial of selepressin in septic shock patients and owing to the small sample size which could have limited the overall impact, more investigation is warranted to evaluate the potential of selepressin in improving treatment outcomes in septic shock patients, said the researchers.

The ongoing SEPSIS-ACT* trial is assessing the superiority of rapid and full substitution of norepinephrine with selepressin over cotreatment with selepressin and norepinephrine, noted the researchers.

“[T]he potential additional benefits of selepressin compared with vasopressin … may justify earlier use and fuller substitution of norepinephrine with selepressin,” they said.

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 4 days ago

The combined use of piperacillin and tazobactam does not appear to be a suitable alternative to meropenem for patients with bloodstream infections caused by ceftriaxone-resistant Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae), according to results of the MERINO* trial.

Tristan Manalac, 19 May 2018
Taking oral antibiotics appears to increase the risk of nephrolithiasis, according to a recent study. Moreover, the risk seems to be compounded for individuals with recent antibiotic exposure and those who were exposed at a younger age.
2 days ago
Patients with inflammatory bowel disease are at increased risk of developing acute myocardial infarction (AMI) or heart failure, although the prevalence of traditional risk factors for such cardiovascular disorders appears to be low, as reported in a recent study.
3 days ago
Early renin-angiotensin-aldosterone system (RAAS) blockade with renin-angiotensin system inhibitors (RASI) leads to better short- and long-term renal outcomes in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN), according to a study, adding that this renal protective effect is independent of RASI’s antihypertensive and antiproteinuric effects.