Our prior research (Crit Care Med, 2003; 31,12:126-453) demonstrated that survival from severe sepsis improved significantly when therapy was initiated earlier. We designed a multidisciplinary Sepsis Pathway to focus resuscitation on Early Goal Directed Therapy. To help establish a control for the Sepsis Pathway, we chose to review the time intervals from the inclusion criteria to resuscitation milestones for Early Goal Directed Therapy (EGDT) (N Engl J Med 2001; 345:1368-1377).
We retrospectively studied patients from 2001-2003 with severe sepsis who received therapy with a Swan-Ganz™ catheter. The five EGDT resuscitation milestones were time in hours to 1) antibiotics, 2) CVP 3 8mmHg, 3) MAP 3 65, 4) ScvO2 or SmvO2 3 70%, and, 5) patient transfer to ICU bed. All time values had a resolution of 15 minutes and were truncated at the first 24 hours. Range, mean and standard deviation were computed by MS Excel.
Twenty patients charts were reviewed. The demographic data was 10 (50 %) male, 10(50 %) female. The average age was 60 years. Mortality at 28 days was 9 out of 20 (45 %).
All milestones are delayed in the treatment of severe sepsis prior to the implementation of EGDT.
Our new designed and implemented Sepsis Pathway is expected to significantly reduce the time of all milestones. We are presently gathering the milestone data prospectively with patients receiving either the PreSep™ or Swan-Ganz™ catheter. Sepsis Treatment Data: Initial 24 hoursPatient #Time to ABXTime to CVPTime to MAPTime to SvO2Time ED->ICU11.7510.250.5010.256.2521.00N/A5.00N/A1.0033.0014.004.0020.00N/A410.001.0025.0024.009.0053.25N/A6.00N/A10.2563.5024.0010.2524.004.7573.2524.008.2524.008.7585.00N/A4.00N/A2.00913.50N/A3.50N/A2.50102.0024.005.75N/A8.251115.00N/A11.00N/A7.00121.003.003.006.00N/A131.00N/A1.00N/AN/A144.00N/A1.0024.005.50156.75N/A1.00N/A3.00169.0024.001.0024.002.50170.75N/A1.000.502.251810.0024.001.0024.002.001917.001.001.00N/A1.00201.004.001.008.500.50hr, range1 - 13.51 - 241 - 10.250.5 - 240.5 - 10.25hr, mean5.5913.934.7117.203.89hr, SD5.1010.365.769.023.20
A. Verceles, Edwards Lifesciences LLC