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Impact of septic shock hemodynamic resuscitation guidelines on rapid early volume replacement and reduced mortality.
J Med Assoc Thai. 2010 Jan; 93 Suppl 1:S102-9.JM

Abstract

BACKGROUND

Septic shock is one of the most serious conditions associated with high mortality. We recently developed a modified septic shock management guideline focusing on rapid restoration of hemodynamics by using clinical endpoint. Our aim was to analyze patients' outcomes following the guideline implementation.

MATERIAL AND METHOD

A retrospective review of hemodynamic data sheet and clinical outcomes of patients admitted to medical ICU and medical Wards and during June 2004 and February 2006.

RESULTS

One hundred and four patients' records were retrieved. The patients' mean age was 62.5 +/- 18.6 year. Their mean APACHE II score were 24.9 +/- 6.7 and the overall mortality was 59%. Sixty eight patients (65.4%) underwent guideline directed therapy (guideline group). The guideline group received higher volume resuscitation from the first hour of resuscitation (1,016.3 + 675.0 ml vs. 521.4 + 359.2 ml, p < 0.001) to the forty eighth hour (10,096.9 +/- 3,256.1 ml vs. 8,067.3 +/- 2,591.9 ml, p = 0.006). More of them achieved the therapeutic goal within 6 hours (86.8% vs. 44.4%, p < 0.001) and their hospital mortality was lower (41.2% vs. 69.4%, p = 0.008). When analyzing differences between those who survived and those who died, more of the surviving patients underwent guideline directed treatment (79.5% vs. 55%, p = 0.012). They received higher volume replacement from the first hour to the end of the twelfth hour (first hour 1,098.0 +/- 723.0 vs. 660.9 +/- 478.9 ml, p < 0.001; the end of the twelfth hour 3,746.6 +/- 1,799 vs. 3,014.1 +/- 1,579.9 ml, p = 0.038) and more of them achieved the therapeutic goal within 6 hours (95.5% vs. 55%, p < 0.001). Multivariate analysis of factors associated with mortality disclosed APACHE II score, volume resuscitation more than 800 ml in the first hour and achievement of the therapeutic goal within 6 hours.

CONCLUSION

Implementation of our modified septic shock guideline is associated with rapid initial volume replacement, prompt achievement of therapeutic goal and improved outcomes. Volume resuscitation greater than 800 ml in the first hour is associated with better survival.

Authors+Show Affiliations

Permpikul C
Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sicpk@mahidol.ac.th
Tongyoo S
No affiliation info available
Ratanarat R
No affiliation info available
Wilachone W
No affiliation info available
Poompichet A
No affiliation info available

MeSH

APACHEAdultAgedAged, 80 and overFemaleFluid TherapyHospital DepartmentsHospital MortalityHumansIntensive Care UnitsLength of StayMaleMiddle AgedOutcome and Process Assessment, Health CarePractice Guidelines as TopicResuscitationRetrospective StudiesShock, SepticSurvival AnalysisTime FactorsTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20364564

Citation

Permpikul, Chairat, et al. "Impact of Septic Shock Hemodynamic Resuscitation Guidelines On Rapid Early Volume Replacement and Reduced Mortality." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 93 Suppl 1, 2010, pp. S102-9.
Permpikul C, Tongyoo S, Ratanarat R, et al. Impact of septic shock hemodynamic resuscitation guidelines on rapid early volume replacement and reduced mortality. J Med Assoc Thai. 2010;93 Suppl 1:S102-9.
Permpikul, C., Tongyoo, S., Ratanarat, R., Wilachone, W., & Poompichet, A. (2010). Impact of septic shock hemodynamic resuscitation guidelines on rapid early volume replacement and reduced mortality. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 93 Suppl 1, S102-9.
Permpikul C, et al. Impact of Septic Shock Hemodynamic Resuscitation Guidelines On Rapid Early Volume Replacement and Reduced Mortality. J Med Assoc Thai. 2010;93 Suppl 1:S102-9. PubMed PMID: 20364564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of septic shock hemodynamic resuscitation guidelines on rapid early volume replacement and reduced mortality. AU - Permpikul,Chairat, AU - Tongyoo,Surat, AU - Ratanarat,Ranistha, AU - Wilachone,Warakarn, AU - Poompichet,Aekarin, PY - 2010/4/7/entrez PY - 2010/4/7/pubmed PY - 2010/5/5/medline SP - S102 EP - 9 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 93 Suppl 1 N2 - BACKGROUND: Septic shock is one of the most serious conditions associated with high mortality. We recently developed a modified septic shock management guideline focusing on rapid restoration of hemodynamics by using clinical endpoint. Our aim was to analyze patients' outcomes following the guideline implementation. MATERIAL AND METHOD: A retrospective review of hemodynamic data sheet and clinical outcomes of patients admitted to medical ICU and medical Wards and during June 2004 and February 2006. RESULTS: One hundred and four patients' records were retrieved. The patients' mean age was 62.5 +/- 18.6 year. Their mean APACHE II score were 24.9 +/- 6.7 and the overall mortality was 59%. Sixty eight patients (65.4%) underwent guideline directed therapy (guideline group). The guideline group received higher volume resuscitation from the first hour of resuscitation (1,016.3 + 675.0 ml vs. 521.4 + 359.2 ml, p < 0.001) to the forty eighth hour (10,096.9 +/- 3,256.1 ml vs. 8,067.3 +/- 2,591.9 ml, p = 0.006). More of them achieved the therapeutic goal within 6 hours (86.8% vs. 44.4%, p < 0.001) and their hospital mortality was lower (41.2% vs. 69.4%, p = 0.008). When analyzing differences between those who survived and those who died, more of the surviving patients underwent guideline directed treatment (79.5% vs. 55%, p = 0.012). They received higher volume replacement from the first hour to the end of the twelfth hour (first hour 1,098.0 +/- 723.0 vs. 660.9 +/- 478.9 ml, p < 0.001; the end of the twelfth hour 3,746.6 +/- 1,799 vs. 3,014.1 +/- 1,579.9 ml, p = 0.038) and more of them achieved the therapeutic goal within 6 hours (95.5% vs. 55%, p < 0.001). Multivariate analysis of factors associated with mortality disclosed APACHE II score, volume resuscitation more than 800 ml in the first hour and achievement of the therapeutic goal within 6 hours. CONCLUSION: Implementation of our modified septic shock guideline is associated with rapid initial volume replacement, prompt achievement of therapeutic goal and improved outcomes. Volume resuscitation greater than 800 ml in the first hour is associated with better survival. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/20364564/Impact_of_septic_shock_hemodynamic_resuscitation_guidelines_on_rapid_early_volume_replacement_and_reduced_mortality_ DB - PRIME DP - Unbound Medicine ER -