PURPOSE: We believe that physicians may modify the goals of care proposed in the Surviving Sepsis Campaign(1) for patients with systolic left ventricular dysfunction (SLVD) and sepsis because of intrinsic hemodynamic abnormalities in such patients. We utilized an institutional quality improvement database to learn if improved sepsis outcomes were associated with the application of a protocol based on the tenets of early goal directed therapy for sepsis in patients with SLVD and sepsis.
METHODS: A retrospective review of a quality improvement database was performed for the period from June 1, 2006 through November 15, 2009. From 1267 database records, we identified 183 sepsis episodes where the patient had pre-existing (prior to the sepsis event) ECHO data documenting an LVEF of 50% or less. Patients were subsequently divided into two groups: those who were treated in accordance with a pre-existing early goal directed therapy protocol for sepsis and those who were not. The sepsis bundle protocol employed at our institution was previously described by Rivers and colleagues(2).
RESULTS: There were 135 patients in Group A whose care did not meet sepsis bundle protocol adherence requirements. The mortality rate in Group A was 36.3%. The 48 patients in Group B had care that met sepsis bundle protocol adherence requirements. The mortality rate in group B was 16.67%. The difference in the mortality rates between the two groups is statistically significant by Chi-Square analysis (p<0.05; Chi-Square statistic =5.479). The LVEF, mean APACHE II score, and the gender ratio were not different between groups A and B (34.46% versus 37.08%; 20.35 versus 18.77; 63.7% men versus 60.4% men).
CONCLUSION: Improved in-hospital mortality was associated with treatment via a protocol using the tenets of early goal directed therapy for sepsis in patients with a reduced LVEF and sepsis.
CLINICAL IMPLICATIONS: We present preliminary data that sepsis outcomes may be improved in heart failure patients when these patients are treated in accordance with the Surviving Sepsis Campaign guidelines.
DISCLOSURE: Sadia Shah, University grant monies None; Grant monies (from sources other than industry) None; Grant monies (from industry related sources) None; Shareholder None; Employee None; Fiduciary position (of any organization, association, society, etc, other than ACCP None; Consultant fee, speaker bureau, advisory committee, etc. Dr. Ouellette is on the Speaker’ s Bureau for Pfizer, Boehringer Ingleheim, and Astra Zeneca. Dr. Shah does not have any potential conflicts of interest.; Other None; No Product/Research Disclosure Information