CHEST Guidelines-Combination-of-Systemic-Inflammatory-Response-Synd

Combination-of-Systemic-Inflammatory-Response-Synd

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The document discusses multiple health-related issues, focusing primarily on the potential use and evaluation of calcium infusion to manage severe or refractory vasodilatory shock in critically ill patients. Current research on calcium infusion is sparse, particularly regarding its efficacy in raising blood pressure during such shock. Although post-cardiotomy studies indicate some positive hemodynamic effects of intravenous (IV) calcium chloride, they do not directly address its impact on refractory shock. The authors—Jacob C. Jentzer, MD, and colleagues—advocate for additional research to better understand calcium infusion's safety and efficacy in this context before recommending its routine use.<br /><br />Additionally, a section reviews Serafim et al.'s meta-analysis comparing quick Sepsis-related Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria in predicting sepsis and hospital mortality. The analysis suggests that SIRS is superior for diagnosing sepsis, while qSOFA slightly excels in predicting hospital mortality. The author of the review, Ran Xu, MD, from Nantong University, critiques the meta-analysis for its limited search strategy details, lack of manual search protocol, language bias due to English-only sources, and the inclusion of studies with varying sample sizes, suggesting these issues may affect the analysis’ robustness.<br /><br />The response to Xu's critiques, authored by those involved in the original meta-analysis, clarifies their methodology, attributes discrepancies to minor data processing changes by databases, and defends common practices in meta-analyses such as focusing on English-language sources due to English being the predominant language for scientific communication. This exchange highlights ongoing dialogues and reflections on methodological rigor and the challenges in medical research and meta-analysis, underlining the importance of detailed reporting and critical evaluation in advancing clinical practice.

Keywords

calcium infusion

vasodilatory shock

hemodynamic effects

refractory shock

qSOFA

SIRS criteria

sepsis diagnosis

hospital mortality

meta-analysis

methodological rigor