Hemodynamic Effects of Intravenous Calcium Administration on Septic Shock Patients: A Retrospective Study. b c

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1 Hemodynamic Effects of Intravenous Calcium Administration on Septic Shock Patients: A Retrospective Study a a b a a a a c* a b c

3 ʼ ʼ Patient flow. ICU, intensive care unit; DNAR, do not attempt resuscitation; CPA, cardiopulmonary arrest.

4 admission Characteristics of septic shock patients treated with a catecholamine with or without intravenous calcium administration at ICU Calcium treated group (n 112) Noncalcium treated group (n 42) P value Age, y 72 (70 74) 74 (71 78) Men, no. (%) APACHE II score 33.5 ( ) 30.5 ( ) SOFA score * 11.5 ( ) 10.4 ( ) Mean arterial pressure, mmhg 68.1 ( ) 74.3 ( ) Noradrenaline, µg kg min ( ) ( ) Dopamin, µg kg min 3.7 ( ) 4.7 ( ) Vasopressin, units min ( ) ( ) Inotropic score 3.91 ( ) 5.12 ( ) Laboratory data White blood cell count, 1,000 µl 11.9 ( ) 15.0 ( ) Ionized calcium, mmol L 1.12 ( ) 1.15 ( ) Sodium, mmol L 133 ( ) 133 ( ) Potassium, mmol L 3.8 ( ) 3.9 ( ) Creatinine, mg dl 2.2 ( ) 2.1 ( ) Diuresis, ml 24 h 3,473 (2,845 4,101) 3,878 (2,927 4,829) Renal replacement therapy, no. (%) Transfusion RCC, units 2.7 ( ) 1.7 ( ) FFP, units 11.0 ( ) 5.3 ( ) PC, units 8.8 ( ) 3.4 ( ) Corticosteroids, no. (%) DIC therapy, no. (%) Time interval from ICU admission to calcium administration, hours 3.3 ( ) ICU denotes Intensive Care Unit; APACHE II, acute physiology and chronic health evaluation II; SOFA, sequential organ failure assessment; RCC, red cell concentrate; FFP, fresh frozen plasma; PC, platelet concentrate; DIC, disseminated intravascular coagula tion. Data are means (95% confidence interval). * The SOFA score was missing for 28 patients in the calcium treated group and 14 in the noncalcium treated group. These values in the calcium treated group were obtained when intravenous calcium was administered initially after ICU admission. Total transfusion units within 72 h after ICU admission.

5 Changes in vasoactive inotropic score (VIS) at 1, 3, 6, 24, 48, and 72 h from baseline among septic shock patients treated with a catecholamine with or without intravenous calcium administration Calcium treated group (n 112) Noncalcium treated group (n 42) P value * Baseline After 1 h Δ1 h (1 h baseline) Baseline After 1 h Δ1 h (1 h baseline) Vasoacitve inotropic score (VIS) 7.10 ( ) 8.51 ( ) 1.41 ( ) 7.08 ( ) 5.84 ( ) 1.25 ( 2.06 to 0.44) After 3 h Δ3 h (3 h baseline) After 3 h Δ3 h (3 h baseline) 8.23 ( ) 1.13 ( ) 6.60 ( ) 0.49 ( ) After 6 h Δ6 h (6 h baseline) After 6 h Δ6 h (6 h baseline) 8.32 ( ) 1.22 ( ) 6.18 ( ) 0.91 ( ) After 24 h Δ24 h (24 h baseline) After 24 h Δ24 h (24 h baseline) 7.45 ( ) 0.35 ( ) 3.97 ( ) 3.12 ( ) After 48 h Δ48 h (48 h baseline) After 48 h Δ48 h (48 h baseline) 3.05 ( ) 4.05 ( 5.67 to 2.42) 1.93 ( ) 5.15 ( 8.13 to 2.18) After 72 h Δ72 h (72 h baseline) After 72 h Δ72 h (72 h baseline) 1.62 ( ) 5.47 ( 6.99 to 3.96) 1.06 ( ) 6.02 ( 8.86 to 3.18) * P values assess the differences between the changes in the physiological endpoints at 1, 3, 6, 24, 48, and 72 h from baseline in the calcium treated and noncalcium treated groups. Baseline time in the calcium treated group means the time of first calcium administration, and in the noncalcium treated group means the time of ICU admission. This P value was statistically significant when the Bonferroni correction tested each individual hypothesis at All data are means (95% confidence intervals). Secondary endpoints of septic shock patients treated with a catecholamine with or without intravenous calcium administration Calcium treated group (n 112) Noncalcium treated group (n 42) P value ICU stay, day, mean (95% confidence interval) 9 (7 11) 9 (6 11) Hospital stay, day, mean (95% confidence interval) 35 (29 41) 45 (30 61) In hospital death, no. (%) day death, no. (%) Change in SOFA score 72 h after ICU admission, mean (95% confidence interval) * 2.4 ( 3.2 to 1.7) 2.3 ( 3.2 to 1.4) ICU denotes Intensive Care Unit; SOFA, sequential organ failure assessment. * The SOFA score was missing for 49 patients in the calcium treated group and 24 in the noncalcium treated group.

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