The ICU mortality rate of patients with septic shock was still high upto 54.1%.In first 6 hours of resuscitation, the goals of resuscitation in sepsis shock after adequate fluid resuscitation is MAP ≥65 mmHg. In refractory septic shock patient, prolong shock correlate with poor outcome due to multiple organ failure. Alternative vasopressor in septic shock with catecholamine resistance has been studied such as terlipressin, methylene blue * Terlipressin (TP) mediate vasoconstriction via V1 receptors coupled to phospholipase C, and increases intracellular Ca2+ concentration * Methylene blue (MB) directly inhibits nitric oxide synthase (NOS) by inhibit the enzyme guanylate cyclase (GC)
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
after defined refractory shock (need NE\>0.5 mcg/kg/min) add Methylene blue 1 mg/kg iv drip then 2 hr later drip 0.5 mg/kg/hr\*4 hr (intervention add on to standard care)
after defined refractory shock (need NE\>0.5 mcg/kg/min) add terlipressin 1 mg IV then repeated dose 20 min later if unstable BP (intervention add on to standard care)
Ramathibodi hospital
Bangkok, Thailand
RECRUITINGmortality rate
Time frame: 7 days
time to wean of vasopressor
Time frame: through complete weaning off vasopressor, an average of 24 hours
ICU duration
Time frame: through out off indication need ICU care, an average of 7 days
hemodynamic parameter: Mean arterial pressure (mmHg)
mmHg, A-line monitoring
Time frame: every 30 min after start protocol up to 6 hr then every 1 hr up to 24 hours
hemodynamic parameter: lactate (mmol/l)
mmol/l
Time frame: every 2 hr until 6 hr then every 4 hr until wean off vasopressor up to 24 hours
hemodynamic parameter: urine output (ml)
ml
Time frame: every 2 hr until wean off vasopressor up to 24 hours
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