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Hemodynamic effects of intravenous calcium administration on septic shock patients: a retrospective study
Naoki Ishibashi1, Koji Miyasho, Tetsuhisa Kitamura
1Fukuyama City Hospital Emergency Medical Center, Fukuyama, Hiroshima 721-8511, Japan.
Insights
Intravenous calcium in septic shock patients unresponsive to fluids may offer a brief hemodynamic improvement. However, this effect is short-lived, with no significant impact on longer-term outcomes like organ function or mortality.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
Background:
- Septic shock (SS) is a life-threatening condition characterized by circulatory, cellular, and metabolic abnormalities.
- Patients unresponsive to fluid resuscitation often require vasopressors and inotropes, with calcium potentially playing a role in hemodynamic support.
Purpose of the Study:
- To evaluate the hemodynamic and clinical outcomes of SS patients treated with or without intravenous calcium after fluid resuscitation failure.
Main Methods:
- Retrospective analysis of 154 SS patients unresponsive to fluid resuscitation.
- Comparison of changes in the vasoactive-inotropic score (VIS) between calcium-treated (n=112) and non-calcium-treated (n=42) groups.
- Assessment of secondary outcomes including ICU/hospital length of stay, mortality, and Sequential Organ Failure Assessment (SOFA) score changes.
Main Results:
- A significantly greater improvement in VIS was observed at 1 hour in the calcium-treated group compared to the non-calcium-treated group (1.41 vs. -1.25, p<0.001).
- No significant differences in VIS changes were found at 3, 6, 24, 48, or 72 hours between the groups.
- Secondary outcomes, including mortality and organ function, did not differ significantly between the treatment groups.
Conclusions:
- Intravenous calcium administration in fluid-unresponsive SS patients may provide transient hemodynamic stabilization.
- Calcium treatment did not demonstrate a significant impact on longer-term hemodynamic parameters or clinical outcomes in this cohort.
Abstract:
We evaluated the hemodynamics and outcomes of septic shock (SS) patients who did not respond to fluid resuscitation, after treatment with or without intravenous calcium. We retrospectively collected information on 154 eligible SS patients who were admitted to Fukuyama City Hospital Emergency Medical Center and did not respond to fluid resuscitation. To compare their degree of hemodynamic impairment, we compared the changes in the vasoactive-inotropic score (VIS) in the calcium-treated group (n＝112) and the noncalcium-treated group (n＝42). We compared the length of stay in the intensive care unit (ICU) and hospital, in-hospital deaths, 28-day deaths, and changes in the Sequential Organ Failure Assessment score within 72h of ICU admission between the 2 groups. Changes in the VIS at 1h after the baseline time were significantly greater in the calcium-treated group than in the noncalcium-treated group (1.41 vs. －1.25, respectively;p＜0.001). However, the changes in the VIS at 3, 6, 24, 48, and 72h did not differ between the 2 groups. The secondary outcomes also did not differ between the groups. Our findings indicate that calcium administered to SS patients might reduce their hemodynamic stabilization, but only for a short time after its administration.
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