• Ryoung-Eun Ko, Daun Jeong, Sumin Baek, Ryang ChungChiCDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, República de Corea., Young SuhGeeGDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, República de Corea. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan, Joonghyun Ahn, Jinseo Kim, Yeon HwangSungSDepartment of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, República de Corea., Tak LeeGunGDepartment of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, República de Corea., Eun ParkJongJDepartment of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, República de Corea., Gun ShinTaeTDepartment of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, República de Corea., Hwan JoYouYDepartment of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seul, República de Corea., and Korean Shock Society (KoSS) Investigators.
• Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, República de Corea.
• Emergencias. 2024 Jun 1; 36 (3): 204210204-210.

ObjectivesTo study the impact of a restrictive calcium replacement protocol in comparison with a liberal one in patients with septic shock.Material And MethodsMulticenter retrospective before-after study that estimated the impact of implementing a restrictive calcium replacement protocol in patients with septic shock. Patients admitted to an intensive care unit between May 2019 and April 2021 were assigned to liberal calcium replacement, and those admitted between May 2021 and April 2022 were assigned to a restrictive protocol. The primary outcome measure was 28-day mortality. Patients were matched with propensity scores.ResultsA total of 644 patients were included; liberal replacement was used in 453 patients and the restrictive replacement in 191. We paired 553 patients according to propensity scores, 386 in the liberal group and 167 in the restrictive group. Mortality did not differ significantly between the groups at 28 days (35.3% vs 32.3%, respectively; hazard ratio, 0.97; 95% CI, 0.72-1.29) or after resolution of septic shock (81.5% vs 83.8%; hazard ratio, 0.89; 95% CI, 0.73-1.09). Nor did scores on the Sepsis-related Organ Failure Assessment scale differ (2.1 vs 2.6; P = 0.20).ConclusionThe implementation of a restrictive calcium replacement protocol in patients with septic shock was not associated with a decrease in 28-day mortality in comparison with use of a liberal protocol. However, we were able to reduce calcium replacement without adverse effects.

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