Monday, 24 April 2017

Do you shenfu? Shenfu injection for septic shock.

There is probably better quality evidence for shenfu injection for sepsis than the recent craze over Vitamin C… pretty sad considering this awful paper.

Shenfu…?

It’s a “well-known traditional Chinese formulation restoring Yang from collapse, tonifying Qi for relieving desertion…” (It’s made from ginseng and aconite.)

So if you need your Yang restored and your Qi tonified then Shenfu is for you! Especially if you are feeling a bit septic?

Back to this randomized placebo controlled trial…

157 patients with sepsis were randomized to either shenfu injection vs. placebo in addition to usual care.

Inclusion criteria relied on the Third International Consensus Definition for sepsis and septic shock published in 2016… even though this study was conducted from June 2010 to November 2012. Perhaps shenfu makes you see into the future…?

The primary outcome was lots of things… something to do with cellular immunity, CD4, CD8 counts, mHLA-DR expression, ex-vivo endotoxin LPS induced TNF, IL 6 and IL 10 cytokines, length of ICU stay, vasopressor use, illness severity, etc.

Why didn’t they just measure the Yang and Qi?

Believe it or not, the authors state the study was powered to the secondary outcome of mortality at 28 days. They were looking for a “holy shit!” difference of 20% and as such only needed low numbers of patients.  (Could it be they changed their original primary outcome to a secondary one after no difference was found? No….)

Results?

Shenfu was great! (except for mortality… but who cares)

The authors conclude, “these findings suggest that shenfu injection can enhance the cellular immunity of patients with septic shock and could be a promising adjunctive treatment for patients with septic shock.”

So for all of you out there giving Vitamin C for sepsis, perhaps you should mix it with a little shenfu… shouldn’t hurt?



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