***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Introduction The rate of weaning of  vasopressors drugs is usually an empirical choice made by the treating in critically ill patients . We applied fuzzy logic principles to modify intravenous norepinephrine ( noradrenaline ) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock . Methods Septic patients were r and omly assigned to norepinephrine infused either at the clinician 's discretion ( control group ) or under closed-loop control based on fuzzy logic ( fuzzy group ) . The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group . The primary end-point was time to cessation of norepinephrine . The secondary end-points were 28-day survival , total amount of norepinephine infused and duration of mechanical ventilation . Results Nineteen patients were r and omly assigned to fuzzy group and 20 to control group . Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients . Median ( interquartile range ) duration of shock was significantly shorter in the fuzzy group than in the control group ( 28.5 [ 20.5 to 42 ] hours versus 57.5 [ 43.7 to 117.5 ] hours ; P < 0.0001 ) . There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups . The median ( interquartile range ) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group ( 0.6 [ 0.2 to 1.0 ] μg/kg versus 1.4 [ 0.6 to 2.7 ] μg/kg ; P < 0.01 ) . Conclusions Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group . We attribute this reduction to fuzzy control of norepinephrine infusion . Trial registration Trial registration : Clinical trials.gov NCT00763906 The effect of Shenfu on biochemical parameters and survival during resuscitation in patients with septic shock was examined . This was a multicenter , controlled , r and omized , open-label trial carried out in 210 patients with septic shock from seven medical centers in China . They were r and omized to Shenfu or saline . The primary outcome was lactate clearance . The secondary outcomes were shock index normalization , dose of vasopressors , ICU stay , hospital stay , and mortality . A total of 199 patients completed the trial . Blood pressure , heart rate , and other routine lab tests showed no difference between the groups . Lactate levels and lactate clearance were similar between the two groups . Hospital and ICU stay were similar between the two groups . When considering all patients , the 7- and 28-day mortality were similar between the two groups , but when considering only patients with lactate levels ≥4.5 mmol/L , the Shenfu group showed a better 7-day survival than the control group ( 7 days : 83.3 % versus 54.5 % , P = 0.034 ; 28 days : 72.7 % versus 47.6 % , P = 0.092 ) . Shenfu may improve the 7-day survival in patients with impaired lactate clearance ( ≥4.5 mmol/L ) , but the mechanism for this effect is unclear . Additional studies are necessary to characterize the hemodynamic changes after Shenfu infusion . This trial is registered with ChiCTR-TRC-11001369 CONTEXT AND OBJECTIVE Sepsis and septic shock are very common conditions among critically ill patients that lead to multiple organ dysfunction syndrome ( MODS ) and death . Our purpose was to investigate the efficacy of early administration of dexamethasone for patients with septic shock , with the aim of halting the progression towards MODS and death . DESIGN AND SETTING Prospect i ve , r and omized , double-blind , single-center study , developed in a surgical intensive care unit at Hospital das Clínicas , Faculdade de Medicina da Universidade de São Paulo . METHODS The study involved 29 patients with septic shock . All eligible patients were prospect ively r and omized to receive either a dose of 0.2 mg/kg of dexamethasone ( group D ) or placebo ( group P ) , given three times at intervals of 36 hours . The patients were monitored over a seven-day period by means of the sequential organ failure assessment score . RESULTS Patients treated with dexamethasone did not require vasopressor therapy for as much time over the seven-day period as did the placebo group ( p = 0.043 ) . Seven-day mortality was 67 % in group P ( 10 out of 15 ) and 21 % in group D ( 3 out of 14 ) ( relative risk = 0.31 , 95 % confidence interval 0.11 to 0.88 ) . Dexamethasone enhanced the effects of vasopressor drugs . CONCLUSIONS Early treatment with dexamethasone reduced the seven-day mortality among septic shock patients and showed a trend towards reduction of 28-day mortality Introduction In septic shock , pulse pressure or cardiac output variation during passive leg raising are preload dependence indices reliable at predicting fluid responsiveness . Therefore , they may help to identify those patients who need intravascular volume expansion , while avoiding unnecessary fluid administration in the other patients . However , whether their use improves septic shock prognosis remains unknown . The aim of this study was to assess the clinical benefits of using preload dependence indices to titrate intravascular fluids during septic shock . Methods In a single-center r and omized controlled trial , 60 septic shock patients were allocated to preload dependence indices-guided ( preload dependence group ) or central venous pressure-guided ( control group ) intravascular volume expansion with 30 patients in each group . The primary end point was time to shock resolution , defined by vasopressor weaning . Results There was no significant difference in time to shock resolution between groups ( median ( interquartile range ) 2.0 ( 1.2 to 3.1 ) versus 2.3 ( 1.4 to 5.6 ) days in control and preload dependence groups , respectively ) . The daily amount of fluids administered for intravascular volume expansion was higher in the control than in the preload dependence group ( 917 ( 639 to 1,511 ) versus 383 ( 211 to 604 ) mL , P = 0.01 ) , and the same held true for red cell transfusions ( 178 ( 82 to 304 ) versus 103 ( 0 to 183 ) mL , P = 0.04 ) . Physiologic variable values did not change over time between groups , except for plasma lactate ( time over group interaction , P < 0.01 ) . Mortality was not significantly different between groups ( 23 % in the preload dependence group versus 47 % in the control group , P = 0.10 ) . Intravascular volume expansion was lower in the preload dependence group for patients with lower simplified acute physiology score II ( SAPS II ) , and the opposite was found for patients in the upper two SAPS II quartiles . The amount of intravascular volume expansion did not change across the quartiles of severity in the control group , but steadily increased with severity in the preload dependence group . Conclusions In patients with septic shock , titrating intravascular volume expansion with preload dependence indices did not change time to shock resolution , but result ed in less daily fluids intake , including red blood cells , without worsening patient outcome .Trial registration Clinical trials.gov NCT01972828 . Registered 11 October 2013 Introduction Sepsis is associated with the generation of oxygen free radicals and ( lacking ) decreased selenium plasma concentrations . High doses of sodium selenite might reduce inflammation by a direct pro-oxidative effect and may increase antioxidant cell capacities by selenium incorporation into selenoenzymes . We investigated the effects of a continuous administration of high doses of selenium in septic shock patients . Methods A prospect i ve , multicentre , placebo-controlled , r and omized , double-blind study was performed with an intention-to-treat analysis in severe septic shock patients with documented infection . Patients received , for 10 days , selenium as sodium selenite ( 4,000 μg on the first day , 1,000 μg/day on the nine following days ) or matching placebo using continuous intravenous infusion . The primary endpoint was the time to vasopressor therapy withdrawal . The duration of mechanical ventilation , the mortality rates in the intensive care unit , at hospital discharge , and at 7 , 14 , 28 and 180 days and 1 year after r and omization , and adverse events were recorded . Results Sixty patients were included ( placebo , n = 29 ; selenium , n = 31 ) .  The median time to vasopressor therapy withdrawal was 7 days in both groups ( 95 % confidence interval = 5–8 and 6–9 in the placebo and selenium groups , respectively ; log-rank , P = 0.713 ) . The median duration of mechanical ventilation was 14 days and 19 days in the placebo and selenium groups , respectively ( P = 0.762 ) . Mortality rates did not significantly differ between groups at any time point . Rates of adverse events were similar in the two groups . Conclusion Continuous infusion of selenium as sodium selenite ( 4,000 μg on the first day , 1,000 μg/day on the nine following days ) had no obvious toxicity but did not improve the clinical outcome in septic shock patients . Trial Registration = NCT00207844 BACKGROUND In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock , mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal -directed therapy ( EGDT )  , in which intravenous fluids , vasopressors , inotropes , and blood transfusions were adjusted to reach central hemodynamic targets , than among those receiving usual care . We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary . METHODS In 31 emergency departments in the United States , we r and omly assigned patients with septic shock to one of three groups for 6 hours of resuscitation : protocol -based EGDT ; protocol -based st and ard therapy that did not require the placement of a central venous catheter , administration of inotropes , or blood transfusions ; or usual care . The primary end point was 60-day in-hospital mortality . We tested sequentially whether protocol -based care ( EGDT and st and ard-therapy groups combined ) was superior to usual care and whether protocol -based EGDT was superior to protocol -based st and ard therapy . Secondary outcomes included longer-term mortality and the need for organ support . RESULTS We enrolled 1341 patients , of whom 439 were r and omly assigned to protocol -based EGDT , 446 to protocol -based st and ard therapy , and 456 to usual care .  Resuscitation strategies differed significantly with respect to the monitoring of central venous pressure and oxygen and the use of intravenous fluids , vasopressors , inotropes , and blood transfusions . By 60 days , there were 92 deaths in the protocol -based EGDT group ( 21.0 % ) , 81 in the protocol -based st and ard-therapy group ( 18.2 % ) , and 86 in the usual-care group ( 18.9 % ) ( relative risk with protocol -based therapy vs. usual care , 1.04 ; 95 % confidence interval [ CI ] , 0.82 to 1.31 ; P=0.83 ; relative risk with protocol -based EGDT vs. protocol -based st and ard therapy , 1.15 ; 95 % CI , 0.88 to 1.51 ; P=0.31 ) . There were no significant differences in 90-day mortality , 1-year mortality , or the need for organ support . CONCLUSIONS In a multicenter trial conducted in the tertiary care setting , protocol -based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes . ( Funded by the National Institute of General Medical Sciences ; ProCESS Clinical Trials.gov number , NCT00510835 . ) Purpose : The Surviving Sepsis Campaign guidelines recommend hydrocortisone in septic shock only when fluid resuscitation and vasopressors fail to restore hemodynamic stability . Hydrocortisone administration modalities are supported only by low- grade recommendations . Our main objective here was to determine differences in 28-day mortality between two low-dose hydrocortisone regimens for the treatment of septic shock . Methods : We performed a multicenter , prospect i ve , r and omized , double-blind , pilot study in four adult medical intensive care units . Patients presenting septic shock were rapidly administered one of two regimens of hydrocortisone , either a 50-mg intravenous bolus every 6 h during 7 days ( 200-mg group ; n = 59 ) or a 100-mg initial bolus followed by a continuous infusion of 300 mg daily for 5 days ( 300-mg group ; n = 63 ) . Hydrocortisone was stopped abruptly at the end of treatment . Results : There were no significant differences between the 200-mg and 300-mg groups as concerns 28-day mortality ( respectively 52.5 % vs. 44.4 % [ RR 0.84 , 95 % CI , 0.58–1. 
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Conclusions Among 65 septic shock trials , there was a clinical ly relevant amount of heterogeneity in control group mortality rates which was explained only partly by differences in inclusion criteria and reported baseline characteristics