The edition · Emergency & Critical Care
Adding perfusion to vasopressor dose sharpened the definition of refractory septic shock
Capillary refill and lactate at six hours in ANDROMEDA-SHOCK-2, which adolescents with a positive suicide screen go on to attempt, how the Phoenix criteria perform in children, and an FDA supplement for generic epinephrine.
The edition in brief
An exploratory analysis of 1,363 patients in ANDROMEDA-SHOCK-2 found that, after six hours of resuscitation, a noradrenaline-equivalent dose above 0.5 µg/kg/min combined with prolonged capillary refill and non-falling lactate identified a small group (3.9%) with 73.6% 28-day mortality, against 23.7% in everyone else (adjusted HR 4.68); this separated risk far better than vasopressor dose alone. In 2,085 adolescents with a positive suicide risk screen in US emergency departments, 11.6% attempted suicide within three months; a recent attempt, prior self-harm, previous psychiatric admission and hopelessness were the factors associated with an attempt. A meta-analysis of 15 studies found the Phoenix sepsis criteria predicted in-hospital death in children with an AUC of 0.81, better than the older consensus criteria, but specificity fell in ICU cohorts and the criteria are meant for risk stratification, not early screening. The FDA recorded a supplement to an abbreviated application for generic epinephrine on 22 September; this is an administrative action on an existing generic, not a new indication or safety finding.
One in nine adolescents with a positive ED suicide screen attempted within three months
After a positive suicide screen in an adolescent, a recent attempt, self-harm, prior admission and hopelessness flag those needing the closest follow-up.
Phoenix criteria predicted death in children with infection better than the old definition
The Phoenix criteria identify children with infection at high risk of death, but they are not a screen for early sepsis.
FDA supplement recorded for a generic epinephrine application
This is an administrative change to a generic epinephrine approval; clinical use is unchanged.
In anaphylaxis, give adrenaline intramuscularly into the thigh, and repeat if needed
Give intramuscular adrenaline into the thigh at once in anaphylaxis, and repeat at five minutes if needed.
At six hours, high vasopressor dose plus poor perfusion marked a 74% mortality group
At the six-hour review in septic shock, judge severity on capillary refill and lactate as well as vasopressor dose.
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