SESSION TITLE: Sepsis and Septic Shock
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM
PURPOSE: Non- invasive soft tissue oxygen monitoring by near-infrared spectroscopy(NIRS) has been reported to detect abnormalities in the microvascular circulation that are an earlier indicator of shock than vital signs. NIRS measures the microvascular circulation or tissue oxygen saturation (St02). Prior studies have shown that a persistently abnormal St02 after resuscitation correlates with poor outcomes. Little investigation has been done as to the usefulness of St02 at triage as a predictor of acuity. Our objective was to determine if screening patients with possible sepsis by hypotension or SIRS at triage with St02 adds value to the routine vital signs and to determine its’ use as an independent predictor of admission, ICU admission or death.
METHODS: This was a single-center, retrospective study in an emergency center(EC) of a cancer center. One hundred fifty-eight patients who presented to the EC triage with hypotension and /or SIRS had a St02 spot check. The patients’ charts were reviewed and univariate analysis was used to determine if St02 was a predictor of admission, ICU admission, and death. Multivariate analysis was used to determine if St02 was an independent predictor of outcomes when adjusted for mean arterial pressure (MAP), pulse(P), and body temperature(T).
RESULTS: Of patients with St02<70%, 29.8% went to the ICU (N=17) compared to 13.9% (N=14) with St02(70-89%; p=0.015). There was no significant difference in hospital admission or mortality between the two groups 98.3%(N=57) and 94.1%(N=101) (p=0.58) and 14.0% (N=8) and 6.9% (N=7) (p=0.08) respectively. Odds ratio of ICU admission for patients with St02<70% compared to those with St02 70-89% is 2.64 (95% CI: 1.18-5.87; p=0.017). Adjusted odds ratio of ICU admission for patients with St02<70% when adjusted for MAP, P, and T was 2.87(p=0.014).
CONCLUSIONS: Patients with a St02<70% at triage have a significantly increased risk of ICU admission.
CLINICAL IMPLICATIONS: The use of St02 at triage identifies critical patients that may not be recognized by vital signs alone. This tool could be helpful in earlier alignment of hospital resources for these patients.
DISCLOSURE: The following authors have nothing to disclose: Hadil Bazerbashi, Kelly Merriman, Katy Toale, Patrick Chaftari, Maria Cruz Carreras, Jerry Henderson, Sei-Ching Yeung, Terry Rice
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