Advertisement

Early goal-directed therapy prevents organ failure and mortality in severe sepsis and septic shock

  • E. Rivers
  • B. Nguyen
  • S. Havstad
Conference paper

Abstract

The systemic inflammatory response syndrome can be self-limited or progress to severe sepsis and septic shock [1]. Along this continuum, circulatory abnormalities lead to an imbalance between systemic oxygen delivery and demands or global tissue hypoxia [2]. As a modulator to serious illness, global tissue hypoxia is a sentinel development preceding multiple system organ failure and death [2]. This transition to serious illness occurs during the proverbial “golden-hour” when definitive recognition and treatment provide maximum outcome benefit. However, these “golden-hours” can elapse in the emergency department [3], hospital ward [4], and even in the intensive care unit [5].

Keywords

Septic Shock Severe Sepsis Systemic Inflammatory Response Syndrome Intensive Care Unit Admission Central Venous Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Rangel-Frausto MS, Pittet D, Costigan M, et al (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273:117–123PubMedCrossRefGoogle Scholar
  2. 2.
    Beal AL, Cerra FB (1994) Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction. JAMA 271:226–233PubMedCrossRefGoogle Scholar
  3. 3.
    Nguyen HB, Rivers EP, Havstad S, et al (2000) Critical care in the emergency department: a physiologic assessment and outcome evaluation. Acad Emerg Med 7:1354–1361PubMedCrossRefGoogle Scholar
  4. 4.
    Lundberg JS, Peri TM, Wiblin T, et al (1998) Septic shock: an analysis of outcomes for patients with onset on hospital wards versus intensive care units. Crit Care Med 26:1020–1024PubMedCrossRefGoogle Scholar
  5. 5.
    Lefrant JY, Muller L, Bruelle P, et al (2000) Insertion time of the pulmonary artery catheter in critically ill patients. Crit Care Med 28:355–359PubMedCrossRefGoogle Scholar
  6. 6.
    Rady MY, Rivers EP, Nowak RM (1996) Resuscitation of the critically ill in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen samration, and lactate. Am J Emerg Med 14:218–225PubMedCrossRefGoogle Scholar
  7. 7.
    Cortez A, Zito J, Lucas CE, Gerrick SJ (1977) Mechanism of inappropriate polyuria in septic patients. Arch Surg 112:471–476PubMedCrossRefGoogle Scholar
  8. 8.
    Elliott DC (1998) An evaluation of the end points of resuscitation. J Am Coll Surg 187:536–547PubMedCrossRefGoogle Scholar
  9. 9.
    Gattinoni L, Brazzi L, Pelosi P, et al (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 333:1025–1032PubMedCrossRefGoogle Scholar
  10. 10.
    Reinhart K, Rudolph T, Bredle DL, et al (1989) Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest 95:1216–1221PubMedCrossRefGoogle Scholar
  11. 11.
    Friedman G, Silva E, Vincent JL (1998) Has the mortahty of septic shock changed with time. Crit Care Med 26:2078–2086PubMedCrossRefGoogle Scholar
  12. 12.
    Opal SM, Cross AS (1999) Clinical trials for severe sepsis. Past failures, and future hopes. Infect Dis Clin North Am 13:285–297PubMedCrossRefGoogle Scholar
  13. 13.
    Hayes MA, Timmins AC, Yau EH, et al (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722PubMedCrossRefGoogle Scholar
  14. 14.
    Connors AFJ, Speroff T, Dawson NV, et al (1996) The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA 276:889–897PubMedCrossRefGoogle Scholar
  15. 15.
    Haupt MT (1996) Goal-oriented hemodynamic therapy (letter). N Engl J Med 334:799PubMedCrossRefGoogle Scholar
  16. 16.
    Hinds C, Watson D (1995) Manipulating hemodynamics and oxygen transport in critically ill patients (letter). N Engl J Med 333:1074–1075PubMedCrossRefGoogle Scholar
  17. 17.
    Shoemaker WC (1996) Goal-oriented hemodynamic therapy (letter). N Engl J Med 334:799–800PubMedCrossRefGoogle Scholar
  18. 18.
    American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874CrossRefGoogle Scholar
  19. 19.
    Sands KE, Bates DW, Lanken PN, et al (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group. JAMA 278:234–240PubMedCrossRefGoogle Scholar
  20. 20.
    World Medical Association Declaration of Helsinki (2000) Ethical principles for medical research involving human subjects. JAMA 284:3043–3045CrossRefGoogle Scholar
  21. 21.
    Kollef MH, Sherman G, Ward S, Fraser VJ (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115:462–474PubMedCrossRefGoogle Scholar
  22. 22.
    Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine (1999) Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Crit Care Med 27:639–660CrossRefGoogle Scholar
  23. 23.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRefGoogle Scholar
  24. 24.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS 11) based on a European/North American multicenter study [published erratum appears in JAMA 1994 271:1321]. JAMA 270:2957–2963PubMedCrossRefGoogle Scholar
  25. 25.
    Marshall JC, Cook DJ, Christou NV, et al (1995) Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23:1638–1652PubMedCrossRefGoogle Scholar
  26. 26.
    Pittet D, Thievent B, Wenzel RP, et al (1993) Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients. Intensive Care Med 19:265–272PubMedCrossRefGoogle Scholar
  27. 27.
    Bossink AW, Groeneveld J, Hack CE, Thijs LG (1998) Prediction of mortality in febrile medical patients: how useful are systemic inflammatory response syndrome and sepsis criteria? Chest 113:1533–1541PubMedCrossRefGoogle Scholar
  28. 28.
    Rutter CM, Elashoff RM (1994) Analysis of longitudinal data: random coefficient regression modelUng. Stat Med 13:1211–1231PubMedCrossRefGoogle Scholar
  29. 29.
    DeMets DL, Lan KK (1994) Interim analysis: the alpha spending function approach. Stat Med 13:1341–1356PubMedCrossRefGoogle Scholar
  30. 30.
    Bemard GR, Vincent JL, Laterre PF, et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709CrossRefGoogle Scholar
  31. 31.
    Edwards JD, Mayall RM (1998) Importance of the sampling site for measurement of mixed venous oxygen saturation in shock. Crit Care Med 26:1356–1360PubMedCrossRefGoogle Scholar
  32. 32.
    Krafft P, Steltzer H, Hiesmayr M, et al (1993) Mixed venous oxygen saturation in critically ill septic shock patients. The role of defined events. Chest 103:900–906PubMedCrossRefGoogle Scholar
  33. 33.
    Lee J, Wright F, Barber R, Stanley L (1972) Central venous oxygen saturation in shock: a study in man. Anesthesiology 36:472–478PubMedCrossRefGoogle Scholar
  34. 34.
    Scheinman MM, Brown MA, Rapaport E (1969) Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in severely ill cardiac patients. Circulation 40:165–172PubMedCrossRefGoogle Scholar
  35. 35.
    Dahn MS, Lange MP, Jacobs LA (1988) Central mixed and splanchnic venous oxygen saturation monitoring. Intensive Care Med 14:373–378PubMedCrossRefGoogle Scholar
  36. 36.
    Heisehnan D, Jones J, Cannon L (1986) Continuous monitoring of mixed venous oxygen saturation in septic shock. J Clin Monit 2:237–245PubMedCrossRefGoogle Scholar
  37. 37.
    McCaig LF, Burt CW (2001) National Hospital Ambulatory Medical Care Survey: 1999 emergency department summary. Adv Data 1–36Google Scholar
  38. 38.
    Nelson M, Waldrop RD, Jones J, Randall Z (1998) Critical care provided in an urban emergency department. Am J Emerg Med 16:56–59PubMedCrossRefGoogle Scholar
  39. 39.
    Frank ED (1967) A shock team in a general hospital. Anesth Analg 46:740–745PubMedCrossRefGoogle Scholar
  40. 40.
    Dellinger RP (1996) Fundamental critical care support: another merit badge or more? (editorial). Crit Care Med; 24:556–557PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • E. Rivers
  • B. Nguyen
  • S. Havstad

There are no affiliations available

Personalised recommendations