The 2004 Surviving Sepsis Campaign Guidelines (SSCG)emphasize the importance of early aggressive sepsis treatment to reduce mortality. We sought to determine compliance with the SSCG in patients(pts) with sepsis in the ED, specifically the timeliness and extent offluid administration and antimicrobial therapy, the use of earlygoal-directed therapy (EGDT), and the nature of vasopressor use.
Retrospective cohort of consecutive pts with an ED diagnosis of’sepsis’ in ourlarge, urban, county, level I trauma center from 12/03-5/04. Pts wereexcluded if age<18yrs,had arequirement for immediate surgery, DNR status or were incarcerated.
After excluding 23 pts who did not meet inclusion criteria fromall ptswith sepsis (n=107), our cohort consisted of 84 pts with a mean age of 50.2± 19.6 yrs and 49% males. The ethnicity reflects that ofourgeneral ED population (62% latino, 18% caucasian, 11% Asian and9%African American). Mean volume of IV fluid administered in the first 6h in the ED was 1951 ± 1644 ml, with the majority of pts(60.7%) receiving 1-3.5 L. Mean time to antibiotic administration fromtime ofpresentation (4.7 ± 4.3 h) or from physician evaluation (2.3 ± 2.9 h) exceeds the recommended 1 h by the SSCG. Vasopressorswere given to 26 (30.9%) pts, with the majority receiving dopamine(25.0%) and norepinephine (6%) as first line agents. No pt was managed using EGDT. Mean LOS in the ED,ICU and hospital were 21.6 ±18.6h, 8.9 ± 13.8d, and 13.6 ± 18.3 d, respectively.
ED management of pts with sepsis does not currently meet the parameters as set by SSCG. Assessment of 28-day mortality may determine impact of ED treatment of septic pts.
Interventions to optimize compliance with SSCG are needed in the ED.
Maria Rudis, None.