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Perna B, Raparelli V, Tordo Caprioli F, Blanaru OT, Malacarne C, Crosetti C, Portoraro A, Zanotto A, Strocchi FM, Rapino A, Costanzini A, Maritati M, Lazzari R, Spampinato MD, Contini C, De Giorgio R, Guarino M. Sex- and Gender-Based Analysis on Norepinephrine Use in Septic Shock: Why Is It Still a Male World? Microorganisms 2024; 12:821. [PMID: 38674765 PMCID: PMC11052153 DOI: 10.3390/microorganisms12040821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Sex and gender are fundamental health determinants and their role as modifiers of treatment response is increasingly recognized. Norepinephrine is a cornerstone of septic shock management and its use is based on the highest level of evidence compared to dopamine. The related 2021 Surviving Sepsis Campaign (SCC) recommendation is presumably applicable to both females and males; however, a sex- and gender-based analysis is lacking, thus not allowing generalizable conclusions. This paper was aimed at exploring whether sex- and gender-disaggregated data are available in the evidence supporting this recommendation. For all the studies underpinning it, four pairs of authors, including a woman and a man, extracted data concerning sex and gender, according to the Sex and Gender Equity in Research guidelines. Nine manuscripts were included with an overall population of 2126 patients, of which 43.2% were females. No sex analysis was performed and gender was never reported. In conclusion, the present manuscript highlighted that the clinical studies underlying the SCC recommendation of NE administration in septic shock have neglected the likely role of sex and gender as modifiers of treatment response, thus missing the opportunity of sex- and gender-specific guidelines.
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Affiliation(s)
- Benedetta Perna
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Valeria Raparelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Federica Tordo Caprioli
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Oana Teodora Blanaru
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Cecilia Malacarne
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Cecilia Crosetti
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Andrea Portoraro
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Alex Zanotto
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Francesco Maria Strocchi
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Alessandro Rapino
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Anna Costanzini
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Martina Maritati
- Infectious Diseases Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.M.); (C.C.)
| | - Roberto Lazzari
- Emergency Department, Hospital de la Santa Creu I Sant Pau, 08041 Barcelona, Spain;
| | - Michele Domenico Spampinato
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
- Emergency Department, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Carlo Contini
- Infectious Diseases Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.M.); (C.C.)
| | - Roberto De Giorgio
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Matteo Guarino
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
- Emergency Department, University Hospital of Ferrara, 44124 Ferrara, Italy
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Guarino M, Perna B, Cesaro AE, Maritati M, Spampinato MD, Contini C, De Giorgio R. 2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department. J Clin Med 2023; 12:jcm12093188. [PMID: 37176628 PMCID: PMC10179263 DOI: 10.3390/jcm12093188] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Sepsis/septic shock is a life-threatening and time-dependent condition that requires timely management to reduce mortality. This review aims to update physicians with regard to the main pillars of treatment for this insidious condition. METHODS PubMed, Scopus, and EMBASE were searched from inception with special attention paid to November 2021-January 2023. RESULTS The management of sepsis/septic shock is challenging and involves different pathophysiological aspects, encompassing empirical antimicrobial treatment (which is promptly administered after microbial tests), fluid (crystalloids) replacement (to be established according to fluid tolerance and fluid responsiveness), and vasoactive agents (e.g., norepinephrine (NE)), which are employed to maintain mean arterial pressure above 65 mmHg and reduce the risk of fluid overload. In cases of refractory shock, vasopressin (rather than epinephrine) should be combined with NE to reach an acceptable level of pressure control. If mechanical ventilation is indicated, the tidal volume should be reduced from 10 to 6 mL/kg. Heparin is administered to prevent venous thromboembolism, and glycemic control is recommended. The efficacy of other treatments (e.g., proton-pump inhibitors, sodium bicarbonate, etc.) is largely debated, and such treatments might be used on a case-to-case basis. CONCLUSIONS The management of sepsis/septic shock has significantly progressed in the last few years. Improving knowledge of the main therapeutic cornerstones of this challenging condition is crucial to achieve better patient outcomes.
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Affiliation(s)
- Matteo Guarino
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Benedetta Perna
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Alice Eleonora Cesaro
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Martina Maritati
- Infectious and Dermatology Diseases, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Michele Domenico Spampinato
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Carlo Contini
- Infectious and Dermatology Diseases, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
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Association between resuscitation in the critical care resuscitation unit and in-hospital mortality. Am J Emerg Med 2022; 60:96-100. [DOI: 10.1016/j.ajem.2022.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022] Open
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