EARLY GOAL-DIRECTED THERAPY (EGDT) FOR SEVERE SEPSIS/SEPTIC SHOCK: WHICH COMPONENTS OF TREATMENT ARE MORE DIFFICULT TO IMPLEMENT IN A COMMUNITY-BASED EMERGENCY DEPARTMENT?
EARLY GOAL-DIRECTED THERAPY (EGDT) FOR SEVERE SEPSIS/SEPTIC SHOCK: WHICH COMPONENTS OF TREATMENT ARE MORE DIFFICULT TO IMPLEMENT IN A COMMUNITY-BASED EMERGENCY DEPARTMENT?
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DOI：
10.1016/j.jemermed.2011.03.024
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发表时间：
2012-05-01
影响因子：
1.5
通讯作者：
Jule, Michael
中科院分区：
文献类型：
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作者：
O'Neill, Rory;Morales, Javier;Jule, Michael
背景资料：早期目标导向治疗（EGDT）已被证明可以降低严重脓毒症/脓毒性休克患者的死亡率，然而，在急诊科（艾德）实施该方案有时很困难。目的：我们评估了我们的脓毒症协议，以确定EGDT元素更难以实现在我们的社区为基础的ED。方法：这是一个非同期队列研究的成年患者进入脓毒症协议在一个单一的社区医院从2008年7月至2009年3月。审查了以下过程测量的图表：预定义的晶体推注、抗生素给药、中心静脉导管插入、中心静脉压测量、动脉管路插入、血管加压药使用、中心静脉血氧饱和度测量和标准化顺序集的使用。我们还比较了单个成分的依从性与出院生存率。结果：在9个月的时间内，共有98例患者。依从性最高的指标是血管加压药（79%; 95%置信区间[CI] 69-89%）和抗生素使用（78%; 95% CI 68-85%）。依从性最低的指标包括动脉管路放置（42%; 95% CI 32-52%）、中心静脉压测量（27%; 95% CI 18-36%）和中心静脉血氧饱和度测量（15%; 95% CI 7-23%）。57例患者存活至出院（死亡率：33%）。在存活至出院的患者中，EDGT显示统计学显著性的唯一要素是晶体推注（79% vs. 46%）（呼吸率[RR] = 1.76，95% CI 1.11-2.58）。结论：在我们的社区医院，动脉导管放置，中心静脉压测量和中心静脉血氧饱和度测量是EGDT最难实施的要素。存活至出院的患者更有可能接受晶体推注。(C)2012 Elsevier Inc.
Background: Early goal-directed therapy (EGDT) has been shown to reduce mortality in patients with severe sepsis/septic shock, however, implementation of this protocol in the emergency department (ED) is sometimes difficult. Objectives: We evaluated our sepsis protocol to determine which EGDT elements were more difficult to implement in our community-based ED. Methods: This was a non-concurrent cohort study of adult patients entered into a sepsis protocol at a single community hospital from July 2008 to March 2009. Charts were reviewed for the following process measures: a predefined crystalloid bolus, antibiotic administration, central venous catheter insertion, central venous pressure measurement, arterial line insertion, vasopressor utilization, central venous oxygen saturation measurement, and use of a standardized order set. We also compared the individual component adherence with survival to hospital discharge. Results: A total of 98 patients presented over a 9-month period. Measures with the highest adherence were vasopressor administration (79%; 95% confidence interval [CI] 69-89%) and antibiotic use (78%; 95% CI 68-85%). Measures with the lowest adherence included arterial line placement (42%; 95% CI 32-52%), central venous pressure measurement (27%; 95% CI 18-36%), and central venous oxygen saturation measurement (15%; 95% CI 7-23%). Fifty-seven patients survived to hospital discharge (Mortality: 33%). The only element of EDGT to demonstrate a statistical significance in patients surviving to hospital discharge was the crystalloid bolus (79% vs. 46%) (respiratory rate [RR] = 1.76, 95% CI 1.11-2.58). Conclusion: In our community hospital, arterial line placement, central venous pressure measurement, and central venous oxygen saturation measurement were the most difficult elements of EGDT to implement. Patients who survived to hospital discharge were more likely to receive the crystalloid bolus. (C) 2012 Elsevier Inc.