Reversal of refractory septic shock with drotrecogin alpha (activated).
OBJECTIVE
We previously reported that early continuous veno-venous hemodiafiltration (CVVHDF) enables rapid identification of a subgroup of patients with "refractory" septic shock and a 100% risk of death. The objective of this study was to investigate whether early administration of drotrecogin alpha (activated) (DrotAA) to this selected subgroup of septic patients at extremely high risk of death would significantly improve prognosis.


METHODS
Prospective observational study in a medical intensive-care unit of a University Hospital. Twenty-three patients with refractory septic shock were included. "Refractory" shock was defined as persistent circulatory failure despite adequate circulatory support, associated with persisting lactic acidosis despite early CVVHDF. Response to CVVDHF was assessed after 6 h of this continuous procedure. Patients selected by this strategy received DrotAA infusion for four days.


RESULTS
The 28-day mortality rate of the 23 patients was 39%. No difference was observed at inclusion between survivors and nonsurvivors. In patients who finally survived, 12 h of DrotAA infusion was associated with a significant decrease in lactic acidosis and in norepinephrine dose.


CONCLUSIONS
DrotAA therapy was associated with unexpectedly high 28-day survival in patients with "refractory" septic shock.
Vieillard-Baron
A
A
Medical Intensive Care Unit, Service de Réanimation Médicale, Centre Hospitalier Universitaire Ambroise Paré, 9 Avenue Charles de Gaulle, 92104, Boulogne Cedex, France. antoine.vieillard-baron@apr.aphp.fr
Caille
V
V
Charron
C
C
Belliard
G
G
Aegerter
P
P
Page
B
B
Jardin
F
F
D000140:Acidosis, Lactic; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D011446:Prospective Studies; D011486:Protein C / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated