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Restrictive calcium replacement in septic shock: a multicenter before-after intervention study.

Ryoung-Eun Ko1, Daun Jeong2, Sumin Baek3

  • 1Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, República de Corea.

Emergencias : Revista De La Sociedad Espanola De Medicina De Emergencias
|May 31, 2024
PubMed
Summary
This summary is machine-generated.

A restrictive calcium replacement protocol in septic shock patients did not lower 28-day mortality compared to a liberal approach. However, this study demonstrated reduced calcium use without adverse events.

Keywords:
CalcioCalciumEmergency departmentIntensive care unitMortalidadMortalitySeptic shockServicio de UrgenciasShock sépticoUnidad de Cuidados Intensivos

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Area of Science:

  • Critical Care Medicine
  • Clinical Nutrition
  • Pharmacology

Background:

  • Septic shock management involves complex fluid and electrolyte replacement strategies.
  • Calcium levels are crucial in septic shock, but optimal replacement protocols remain debated.
  • Current practices vary, with both liberal and restrictive calcium replacement strategies employed.

Purpose of the Study:

  • To compare the impact of a restrictive versus a liberal calcium replacement protocol in patients with septic shock.
  • To evaluate the effect of these protocols on 28-day mortality and organ function.
  • To assess the safety of implementing a restrictive calcium replacement strategy.

Main Methods:

  • Multicenter retrospective before-and-after study design.
  • Inclusion of intensive care unit patients with septic shock admitted between May 2019 and April 2022.
  • Propensity score matching to compare outcomes between liberal (May 2019-April 2021) and restrictive (May 2021-April 2022) calcium replacement groups.

Main Results:

  • No significant difference in 28-day mortality between the restrictive (32.3%) and liberal (35.3%) calcium replacement groups (HR, 0.97; 95% CI, 0.72-1.29).
  • Similar mortality rates were observed after septic shock resolution (83.8% vs 81.5%; HR, 0.89; 95% CI, 0.73-1.09).
  • No significant difference in Sepsis-related Organ Failure Assessment (SOFA) scores between the groups (2.6 vs 2.1; P = 0.20).

Conclusions:

  • Implementing a restrictive calcium replacement protocol in septic shock patients did not increase mortality compared to a liberal protocol.
  • The study successfully reduced calcium replacement without apparent adverse effects.
  • Findings suggest that restrictive calcium management may be a safe alternative in septic shock.