PURPOSE: 1. To describe the hemodynamic parameters and support used by the medical residents in managing severe sepsis and septic shock admitted in Philippine General Hospital from March 1, 2006 to June 31, 2006. 2. To determine adherence to existing sepsis guidelines on fluid management. 3. To determine the prevalence and etiologies of severe sepsis and septic shock.
METHODS: This is a prospective cohort study on adult with severe sepsis and septic shock admitted under the UP PGH Department of Medicine. The type and amount of fluids given, monitoring of response to treatment and use of inotropic support were reviewed.
RESULTS: 27 (2.8%) cases of severe sepsis and septic shock were admitted. On presentation, 66% presented as septic shock. Nine patients were with severe sepsis and five of them progressed to. Pulmonary (60%) was the most common infectious etiology. 37% had multiple infections. All were resuscitated with crystalloids. Only three severe sepsis patients received adequate fluid management based on existing guidelines. Five cases progressed to septic shock. Shock patients received adequate fluid loading however less than half received adequate fluid maintenance. Inotropic support was given using either dopamine or noradrenaline. Only 22% had a central line for infusion of the inotropic agent. One patient was underdosed with inotropic management. Normalization of blood pressure was the most common parameter used for adequate fluid management. Only 3 out of 6 patients had adequate CVP monitoring. Maintenance of mean arterial pressure was done only in 2 patients. All patients had urine output monitoring however, only 25% of patients had hourly output determination.
CONCLUSION: Severe sepsis and septic shock accounted for 2.8% of medical patients admitted in this tertiary hospital. There is a 66% mortality. The most common focus of infection is pulmonary. There is a discrepancy between the guidelines and the management of patients in this tertiary hospital in the Philippines.
CLINICAL IMPLICATIONS: There is need to reinforce proper maintenance fluid managemnt among physicians in training to increase adherence to existing evidence based guidelines.
DISCLOSURE: Albert Albay, No Financial Disclosure Information; No Product/Research Disclosure Information