PURPOSE: Since 2004, we have treated patients with Severe Sepsis (SS) using a therapeutic guideline as reported in Chest 2004; 126(4, Suppl):863S and Chest 2005; 128(4, Supp): 181S. We questioned what factors may influence survival in patients treated at our institution.
METHODS: The records of patients with SS treated using the Hahnemann University Hospital Severe Sepsis Guideline were reviewed. Data were recorded on: a) severity of illness by APACHE II score, b) route of admission to ICU, c) time of onset of Severe Sepsis to antibiotic administration, time to achievement of hemodynamic goals, d) pressors administered, e) volume infused in 6 hours, and f) transfusion requirements. The subjects were divided by mortality. A spreadsheet using Microsoft Excel was created and data tabulation and statistical analysis performed. This project was approved by our Institutional Review Board.
RESULTS: Fifty three patients were studied. The mortality at 28 days was 17/53 = 32%. Of those that survived (36 vs 17), 36% were admitted from the ED, vs 64% of those that died. The mean APACHE II score of survivors was 26.1 vs. 26.8. The survivors also reached all hemodynamic goals in less time than those that died. Survivors required less volume (3850ml vs. 4721ml), more vasopressors (64% vs. 53%), and less tranfusions (28% vs 35%) than those that died.
CONCLUSION: 1. Patients with severe sepsis who presented to the ED and then transferred to the MICU had a higher mortality than those with SS who transferred within the hospital to the MICU. 2. Patients who survived reached their CVP, MAP and ScvO2 milestones faster. 3. Patients who survived required less volume resuscitation. 4. Patients who survived were more likely to require vasopressors. 5. Patients who survived were less likely to require transfusions.
CLINICAL IMPLICATIONS: Factors elucidated by clinicians utilizing a Severe Sepsis Guideline can provide insight into patients’ outcome and utilization of resources. Additional retrospective studies can be conducted with this database, which could be expanded to multiple clinical centers.
DISCLOSURE: Avelino Verceles, None.