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Báo cáo y học: "One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. | Available online http ccforum.eom content 13 5 R167 Research One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock a before and after study Michael A Puskarich Michael R Marchick Jeffrey A Kline Michael T Steuerwald and Alan E Jones Department of Emergency Medicine Carolinas Medical Center 1000 Blythe Blvd Charlotte North Carolina 28203 USA Corresponding author Alan E Jones alan.jones@carolinas.org Received 9 Jul 2009 Revisions requested 17 Sep 2009 Revisions received 1 Oct 2009 Accepted 21 Oct 2009 Published 21 Oct 2009 Critical Care 2009 13 R167 doi 10.1186 cc8138 This article is online at http ccforum.com content 13 5 R1 67 2009 Puskarich et al. licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License http creativecommons.org licenses by 2.0 which permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited. Open Access Abstract Introduction Early structured resuscitation of severe sepsis has been suggested to improve short term mortality however no previous study has examined the long-term effect of this therapy. We sought to determine one year outcomes associated with implementation of early goal directed therapy EGDT in the emergency department ED care of sepsis. Methods We performed a longitudinal analysis of a prospective before and after study conducted at a large urban ED. Adult patients were enrolled if they had suspected infection 2 or more systemic inflammatory response criteria and either systolic blood pressure SBP 90 mmHg after a fluid bolus or lactate 4 mM. Exclusion criteria were age 18 years no aggressive care desired or need for immediate surgery. Clinical and outcomes data were prospectively collected on consecutive eligible patients for 1 year before and 2 years after implementing EGDT. Patients in the pre-implementation phase