Outcomes from implementing early goal-directed therapy for severe sepsis and septic shock : A 4-year observational cohort study

摘要

Objectives: The aim of this study was to determine the outcome of patients with severe sepsis and septic shock who did and did not receive early goal-directed therapy (EGDT) in the emergency department (ED). The primary end point was the in-hospital mortality rate. The secondary end points were lengths of stay in the ICU and in hospital. Method: Patients with sepsis who satisfied two of the four systemic inflammatory response criteria and who either had a lactate of greater than 4 mmol/l or a systolic blood pressure of less than 90 mmHg after 20-30 ml/kg of fluid, were included. Patients who had EGDT commenced, and all patients who were admitted to ICU who met EGDT criteria over a 4-year period from 1 January 2006 to 31 December 2009, were studied. Results: One hundred and seventy-four patients with sepsis met the criteria for EGDT. Ninety-seven patients had EGDT commenced in the ED. The mortality rate in the EGDT group was 22.7% compared with 42.9% in the non-EGDT group (P=0.004). The length of stay in ICU was [(median and interquartile range)] 3D(5) versus 4D(8), P value less than 0.0001. There was no difference in the length of in-hospital stay. Conclusion: Initiating EGDT in the ED in patients with severe sepsis and septic shock was associated with a significant reduction in in-hospital mortality and length of stay in ICU.