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What's New in Shock, October 2019?

The October 2019 issue of SHOCK showcases a wide range In doing so, the investigators report on one of the largest cohorts of clinical and basic research studies from around the globe. The clinical studies are focused on sepsis and septic shock, the factors and patient characteristics associated with both short and long-term outcome after sepsis and septic shock, and potential new biomarkers for predicting sepsis-induced end organ damage. The basic science aspects of this month’s issue of SHOCK represent a diverse collection of studies providing new insight into potential mechanisms underlying vascular endothelial cell damage and intestinal epithelial cell injury after hemorrhage, large animal modeling of ventilation and oxygenation-induced pathophysiology, new tools for assessing and improving cardiac function after hemorrhage, cardiac arrest, and endotoxemia, as well as a large animal trial of antithrombin III as a potential therapeutic in endotoxin-induced disseminated intravascular coagulation. Perhaps equally as impressive as the quality of the studies is that they come from laboratories and research groups spanning multiple continents, highlighting the global reach of our research community, and our interconnected mission to better understand the biology of trauma, shock, and sepsis. In the first clinical study by Udy et al. (1), a post hoc analysis of the ARISE trial was performed to examine the association between early vasopressor use and mortality in septic shock. The 2014 Australasian Resuscitation in Sepsis Evaluation (ARISE) trial was a randomized, multicenter, clinical trial that enrolled 1,600 patients with severe sepsis or septic shock to Early Goal Directed Therapy (EGDT) or standard physician care. The trial demonstrated no difference in the primary outcome of all-cause mortality at 90 days. Udy et al. turned to the ARISE data to test the hypothesis that earlier use of vasopressors would be independently associated with differential 90-day mortality. Using three different statistical models the authors made a consistent finding that early vasopressor use was associated with greater 90-day mortality. While the authors acknowledge that early vasopressor use may be a marker of greater illness severity, their study also poses an interesting consideration for the development of future clinical trials. The next clinical study by Baudry et al. (2) is a long-term observational study of cirrhotic patients admitted to the ICU with septic shock. The authors retrospectively analyzed this cohort to identify potential risk factors for short and long-term outcomes.