J Med Assoc Thai 2010; 93 (1):102

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Impact of Septic Shock Hemodynamic Resuscitation Guidelines on Rapid Early Volume Replacement and Reduced M
Permpikul C Mail, Tongyoo S , Ratanarat R , Wilachone W , Poompichet A

Background: Septic shock is one of the most serious conditions associated with high mortality. We recently
developed a modified septic shock management guideline focusing on rapid restoration of hemodynamics by
using clinical endpoint. Our aim was to analyze patients’ outcomes following the guideline implementation.

Material and Method:
A retrospective review of hemodynamic data sheet and clinical outcomes of patients
admitted to medical ICU and medical Wards and during June 2004 and February 2006.

Results: One hundred and four patients’ records were retrieved. The patients’ mean age was 62.5 + 18.6 year.
Their mean APACHE II score were 24.9 + 6.7 and the overall mortality was 59%. Sixty eight patients (65.4%)
underwent guideline directed therapy (guideline group). The guideline group received higher volume resuscitation
from the first hour of resuscitation (1,016.3 + 675.0 ml vs. 521.4 + 359.2 ml, p < 0.001) to the forty
eighth hour (10,096.9 + 3,256.1 ml vs. 8,067.3 + 2,591.9 ml, p = 0.006). More of them achieved the therapeutic
goal within 6 hours (86.8% vs. 44.4%, p < 0.001) and their hospital mortality was lower (41.2% vs. 69.4%,
p = 0.008). When analyzing differences between those who survived and those who died, more of the surviving
patients underwent guideline directed treatment (79.5% vs. 55%, p = 0.012). They received higher volume
replacement from the first hour to the end of the twelfth hour (first hour 1,098.0 + 723.0 vs. 660.9 + 478.9 ml,
p < 0.001; the end of the twelfth hour 3,746.6 + 1,799 vs. 3,014.1 + 1,579.9 ml, p = 0.038) and more of them
achieved the therapeutic goal within 6 hours (95.5% vs. 55%, p < 0.001). Multivariate analysis of factors
associated with mortality disclosed APACHE II score, volume resuscitation more than 800 ml in the first hour
and achievement of the therapeutic goal within 6 hours.

Conclusion: Implementation of our modified septic shock guideline is associated with rapid initial volume
replacement, prompt achievement of therapeutic goal and improved outcomes. Volume resuscitation greater
than 800 ml in the first hour is associated with better survival.

Keyword: Septic shock, Hemodynamic guideline, Fluid therapy

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