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Association Between Timing of Central Venous Line Insertion and Outcomes of Early Goal Directed Therapy in Severe Sepsis FREE TO VIEW

Ravi Patel, MD; Michele Ho, MD; Erkan Hassan, PharmD; Rakesh Alva, MD
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ConeHealth System, Greensboro, NC

Chest. 2013;144(4_MeetingAbstracts):414A. doi:10.1378/chest.1698993
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate the effect of timing of central venous line insertion (CVLI) with early goal directed therapy (EGDT) on clinical outcomes of patients with severe sepsis (SS).

METHODS: Patients from a community hospital emergency department (ED) diagnosed with SS from 1/11 to 6/12 were started on surviving sepsis campaign (SSC) bundles. Time of ED triage was taken as T-zero. Only patients meeting SSC criteria for CVLI and receiving EGDT were analyzed. Time of CVL placement in hourly increments from T-zero to six hours, was determined. Resuscitation bundle compliance, ICU length of stay (LOS), ICU mortality, and hospital LOS were evaluated based on time of CVLI. Statistical analysis consisted of chi square, unpaired student’s t-test and ANOVA where appropriate.

RESULTS: 121 patients met entry criteria, 23 patients were excluded (CVLI > 6 hours). Of the remaining 98 patients, overall findings were (mean + SD): age 63.9 (15.4) yrs, 63.8% male, APACHE IV 81.9 (35.3), resuscitation bundle compliance 38.8%, ICU LOS 7.5 (7.0) days and ICU mortality 24.5%. A statistically significant greater number of patients achieved compliance with the 6 hour resuscitation bundle when CVLI occurred from 0-4 hours vs 4-6 hours (46.0% vs 16.7% P=0.011). A trend was observed as early as 3 hours (P=0.06). ICU LOS, ICU Mortality, Hospital LOS, Age and APACHE IV scores were comparable between the 0-4 hour group and 4-6 hour group (P>0.05).

CONCLUSIONS: An association exists between CVLI within 4 hours of ED triage in SS patients and resuscitation bundle compliance. A larger study is needed to determine if a positive impact on clinical outcomes is actually present, or if CVLI within 3 hours would be significant.

CLINICAL IMPLICATIONS: New SSC guidelines recommend early antibiotic administration to improve outcomes of SS patients receiving EGDT. Similarly, earlier CVLI improves resuscitation bundle compliance. A larger sample size will help confirm the presence or absence of clinical outcome benefits.

DISCLOSURE: The following authors have nothing to disclose: Ravi Patel, Michele Ho, Erkan Hassan, Rakesh Alva

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