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

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Book cover Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.
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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].

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References

  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 273:117–123

    Article  PubMed  CAS  Google Scholar 

  2. Beal AL, Cerra FB (1994) Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction. JAMA 271:226–233

    Article  PubMed  CAS  Google Scholar 

  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 7:1354–1361

    Article  PubMed  CAS  Google Scholar 

  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 26:1020–1024

    Article  PubMed  CAS  Google Scholar 

  5. Lefrant JY, Muller L, Bruelle P, et al (2000) Insertion time of the pulmonary artery catheter in critically ill patients. Crit Care Med 28:355–359

    Article  PubMed  CAS  Google Scholar 

  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 14:218–225

    Article  PubMed  CAS  Google Scholar 

  7. Cortez A, Zito J, Lucas CE, Gerrick SJ (1977) Mechanism of inappropriate polyuria in septic patients. Arch Surg 112:471–476

    Article  PubMed  CAS  Google Scholar 

  8. Elliott DC (1998) An evaluation of the end points of resuscitation. J Am Coll Surg 187:536–547

    Article  PubMed  CAS  Google Scholar 

  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 333:1025–1032

    Article  PubMed  CAS  Google Scholar 

  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 95:1216–1221

    Article  PubMed  CAS  Google Scholar 

  11. Friedman G, Silva E, Vincent JL (1998) Has the mortahty of septic shock changed with time. Crit Care Med 26:2078–2086

    Article  PubMed  CAS  Google Scholar 

  12. Opal SM, Cross AS (1999) Clinical trials for severe sepsis. Past failures, and future hopes. Infect Dis Clin North Am 13:285–297

    Article  PubMed  CAS  Google Scholar 

  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 330:1717–1722

    Article  PubMed  CAS  Google Scholar 

  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 276:889–897

    Article  PubMed  Google Scholar 

  15. Haupt MT (1996) Goal-oriented hemodynamic therapy (letter). N Engl J Med 334:799

    Article  PubMed  CAS  Google Scholar 

  16. Hinds C, Watson D (1995) Manipulating hemodynamics and oxygen transport in critically ill patients (letter). N Engl J Med 333:1074–1075

    Article  PubMed  CAS  Google Scholar 

  17. Shoemaker WC (1996) Goal-oriented hemodynamic therapy (letter). N Engl J Med 334:799–800

    Article  PubMed  CAS  Google Scholar 

  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 20:864–874

    Article  Google Scholar 

  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 278:234–240

    Article  PubMed  CAS  Google Scholar 

  20. World Medical Association Declaration of Helsinki (2000) Ethical principles for medical research involving human subjects. JAMA 284:3043–3045

    Article  Google Scholar 

  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 115:462–474

    Article  PubMed  CAS  Google Scholar 

  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 27:639–660

    Article  Google Scholar 

  23. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  PubMed  CAS  Google Scholar 

  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 270:2957–2963

    Article  PubMed  Google Scholar 

  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 23:1638–1652

    Article  PubMed  CAS  Google Scholar 

  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 19:265–272

    Article  PubMed  CAS  Google Scholar 

  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 113:1533–1541

    Article  PubMed  CAS  Google Scholar 

  28. Rutter CM, Elashoff RM (1994) Analysis of longitudinal data: random coefficient regression modelUng. Stat Med 13:1211–1231

    Article  PubMed  CAS  Google Scholar 

  29. DeMets DL, Lan KK (1994) Interim analysis: the alpha spending function approach. Stat Med 13:1341–1356

    Article  PubMed  CAS  Google Scholar 

  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 344:699–709

    Article  Google Scholar 

  31. Edwards JD, Mayall RM (1998) Importance of the sampling site for measurement of mixed venous oxygen saturation in shock. Crit Care Med 26:1356–1360

    Article  PubMed  CAS  Google Scholar 

  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 103:900–906

    Article  PubMed  CAS  Google Scholar 

  33. Lee J, Wright F, Barber R, Stanley L (1972) Central venous oxygen saturation in shock: a study in man. Anesthesiology 36:472–478

    Article  PubMed  CAS  Google Scholar 

  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 40:165–172

    Article  PubMed  CAS  Google Scholar 

  35. Dahn MS, Lange MP, Jacobs LA (1988) Central mixed and splanchnic venous oxygen saturation monitoring. Intensive Care Med 14:373–378

    Article  PubMed  CAS  Google Scholar 

  36. Heisehnan D, Jones J, Cannon L (1986) Continuous monitoring of mixed venous oxygen saturation in septic shock. J Clin Monit 2:237–245

    Article  PubMed  CAS  Google Scholar 

  37. McCaig LF, Burt CW (2001) National Hospital Ambulatory Medical Care Survey: 1999 emergency department summary. Adv Data 1–36

    Google Scholar 

  38. Nelson M, Waldrop RD, Jones J, Randall Z (1998) Critical care provided in an urban emergency department. Am J Emerg Med 16:56–59

    Article  PubMed  CAS  Google Scholar 

  39. Frank ED (1967) A shock team in a general hospital. Anesth Analg 46:740–745

    Article  PubMed  CAS  Google Scholar 

  40. Dellinger RP (1996) Fundamental critical care support: another merit badge or more? (editorial). Crit Care Med; 24:556–557

    Article  PubMed  CAS  Google Scholar 

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Rivers, E., Nguyen, B., Havstad, S. (2003). Early goal-directed therapy prevents organ failure and mortality in severe sepsis and septic shock. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2215-7_38

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  • DOI: https://doi.org/10.1007/978-88-470-2215-7_38

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0194-7

  • Online ISBN: 978-88-470-2215-7

  • eBook Packages: Springer Book Archive

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