Ferrer R, Artigas A, Suarez D, Palencia E, Levy MM, Arenzana A, Pérez XL, Sirvent JM
Effectiveness of Treatments for Severe Sepsis: A Prospective Multicenter Observational Study. [JOURNAL ARTICLE]
Am J Respir Crit Care Med 2009 Aug 20.
RATIONALE: Several Surviving Sepsis Campaign Guidelines recommendations are being reevaluated.
OBJECTIVES: To analyze the effectiveness of treatments recommended in the sepsis guidelines.
METHODS: In a prospective observational study, we studied all adult patients with severe sepsis from 77 intensive care units. We recorded compliance with 4 therapeutic goals (central venous pressure >/= 8 mmHg for persistent hypotension despite fluid resuscitation and/or lactate > 36 mg/dl; central venous oxygen saturation >/= 70% for persistent hypotension despite fluid resuscitation and/or lactate > 36 mg/dl; blood glucose >/= lower limit of normal but < 150 mg/dl; and inspiratory plateau pressure < 30 cmH2O for mechanically ventilated patients) and 4 treatments (Early broad spectrum antibiotics; fluid challenge in the event of hypotension and/or lactate > 36 mg/dl; low-dose steroids for septic shock; drotrecogin alfa (activated) for multiorgan failure). The primary outcome measure was hospital mortality. The effectiveness of each treatment was estimated using propensity scores.
MEASUREMENTS AND MAIN RESULTS: Of 2,796 patients, 41.6% died before hospital discharge. Treatments associated with lower hospital mortality were: early broad spectrum antibiotic treatment (treatment within 1h vs. no treatment within first 6h of diagnosis, Odds Ratio 0.67; 95% Confidence Interval 0.50-0.90; P= 0.008) and drotrecogin alfa (activated) (Odds Ratio 0.59; 95% Confidence Interval 0.41-0.84 ; P= 0.004). Fluid challenge and low dose steroids showed no benefits.
CONCLUSIONS: In severe sepsis, early administration of broad spectrum antibiotics in all patients and administration of drotrecogin alfa (activated) in the most severe patients reduce mortality.
More from this journal |
