The Impact of Intensive Care Unit Admissions Following Early Resuscitation on the Outcome of Patients with Severe Sepsis and Septic Shock
Surat Tongyoo MD*1, Tanuwong Viarasilpa MD*1, Chairat Permpikul MD*1
Affiliation : *1 Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Septic shock is a serious condition associated with a high mortality rate. The “Early goal-directed therapy” has
been reported as the effective treatment. Whether or not an intensive care unit (ICU) admission can improve the outcomes of
septic shock patients, has not been elucidated.
Objective : To evaluate the impact of direct ICU admission after initial resuscitation in the emergency room (ER) on the
outcomes of patients in septic shock.
Material and Method: A prospective cohort study including severe sepsis and septic shock patients who were admitted from
the ER during the period from April 2011 to September 2012. The recorded information includes patients’ baseline
characteristics, hemodynamic parameters, and outcomes. The comparisons were performed between the ICU versus the
non-ICU admission groups. The principal outcome was 28-day mortality.
Results : Of the 175 enrolled patients, 50 patients were directly admitted to the ICU and 125 patients were admitted to a general
medical ward. The ICU patients were younger (58.6+19.7 vs. 66.0+15.1 year-old, p = 0.02), had lower mean arterial blood
pressures (57.8+15.3 vs. 66.6+18.4 mmHg, p<0.001) and presented with a higher proportion of metabolic acidosis (60%
vs. 33.6%, p = 0.002). In comparison to the non-ICU group, the ICU patients received larger volume resuscitation for the
first 24 hours (5,694.4+2,018.5 vs. 5,004.7+1,729.7 ml, p = 0.04); had received norepinephrine (88% vs. 68%, p = 0.007)
and/or dobutamine (20% vs. 4.8%, p = 0.003), and were treated for renal replacement therapy (28% vs. 5.6%, p<0.001) in
higher proportions. There were trends toward a lower 28 day mortality (18% vs. 25.6%, p = 0.33) among the patients in the
ICU group.
Conclusions: Apart from the early goal-directed therapy, early ICU admission substantially improves the outcomes of septic
shock patients.
Keywords : Septic shock, Intensive care unit, ICU
