Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study
Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study
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DOI：
10.1186/s40560-019-0407-z
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发表时间：
2019-12-02
影响因子：
7.1
通讯作者：
West, T. Eoin
中科院分区：
文献类型：
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作者：
Rudd, Kristina E.;Hantrakun, Viriya;West, T. Eoin
脓毒症的负担在低收入和中等收入国家最高，尽管在这些环境中脓毒症的管理特征很差。因此，本研究的目的是评估泰国败血症的早期管理。方法对Ubon脓毒症研究进行预先计划的分析，该研究是一项单中心前瞻性队列研究，研究对象为入住区域转诊医院普通内科病房和重症监护室（ICU）的社区获得性脓毒症患者。结果2013年3月至2017年1月期间，共招募了3，716例脓毒症患者。中位年龄为59岁（IQR 44-72，范围18-101），58%为男性，88%从其他医院转移。86%的患者（N = 3，206）在急诊科（艾德）接受评价，中位住院时间小于1小时。在入院的第一天内，大多数患者（83%，N = 3，089）入住普通内科病房，17%入住ICU。入住ICU的患者年龄、性别和合并症相似，但器官功能障碍更多，更有可能接受可测量的脓毒症管理干预。总体而言，84%（N = 3，136）在入院第一天内进行了血培养，89%（N = 3，308）接受了抗生素治疗。在普通内科病房收治的3，089例患者中，38%（N = 1，165）接受了肾上腺素能药物治疗，21%（N = 650）接受了有创机械通气。28天的总死亡率为21%（765/3，716），入住ICU的患者的28天死亡率高于第一天入住普通内科病房的患者（42% [263/627] vs. 16% [502/3，089]，p < 0.001）。结论：在泰国农村地区转诊医院，尽管呼吸衰竭和休克的发生率很高，但一些重症监护资源有限，脓毒症通常在普通内科病房进行管理。加强艾德和普通病房的脓毒症护理，以及改善ICU的可及性，可能有利于降低死亡率。
Background The burden of sepsis is highest in low- and middle-income countries, though the management of sepsis in these settings is poorly characterized. Therefore, the objective of this study was to assess the early management of sepsis in Thailand. Methods Pre-planned analysis of the Ubon-sepsis study, a single-center prospective cohort study of Thai adults admitted to the general medical wards and medical intensive care units (ICUs) of a regional referral hospital with community-acquired sepsis. Results Between March 2013 and January 2017, 3,716 patients with sepsis were enrolled. The median age was 59 years (IQR 44-72, range 18-101), 58% were male, and 88% were transferred from other hospitals. Eighty-six percent of patients (N = 3,206) were evaluated in the Emergency Department (ED), where median length of stay was less than 1 hour. Within the first day of admission, most patients (83%, N = 3,089) were admitted to the general medical wards, while 17% were admitted to the ICUs. Patients admitted to the ICUs had similar age, gender, and comorbidities, but had more organ dysfunction and were more likely to receive measured sepsis management interventions. Overall, 84% (N = 3,136) had blood cultures ordered and 89% (N = 3,308) received antibiotics within the first day of hospital admission. Among the 3,089 patients admitted to the general medical wards, 38% (N = 1,165) received an adrenergic agent, and 21% (N = 650) received invasive mechanical ventilation. Overall mortality at 28 days was 21% (765/3,716), and 28-day mortality in patients admitted to the ICUs was higher than that in patients admitted to the general medical wards within the first day (42% [263/627] vs. 16% [502/3,089], p < 0.001). Conclusions Sepsis in a regional referral hospital in rural Thailand, where some critical care resources are limited, is commonly managed on general medical wards despite high rates of respiratory failure and shock. Enhancing sepsis care in the ED and general wards, as well as improving access to ICUs, may be beneficial in reducing mortality.