Compliance with vasopressor use of early goal-directed therapy is not associated with decreased mortality in severe sepsis/septic shock

cc7038 CCJ Poster presentation Compliance with vasopressor use of early goal-directed therapy is not associated with decreased mortality in severe sepsis/septic shock Afessa Bekele Mullon J John Cartin-Ceba Rodrigo Schramm E Garrett Gajic Ognjen

Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA

Critical Care Sepsis 2008 Steven Opal, Tom van der Poll, John Marshall and Konrad Reinhart Meeting abstracts http://ccforum.com/supplements/notes/ccv12s5-info.pdf Sepsis 2008 Granada, Spain

19–22 November 2008

http://www.sepsisforum.org 1364-8535 2008 12 Suppl 5 P5 http://ccforum.com/content/12/S5/P5 10.1186/cc7038 18 11 2008 2008 Afessa et al; licensee BioMed Central Ltd.

Background

Early goal-directed therapy (EGDT) reduces mortality of severe sepsis/septic shock by 16%. The elements of EGDT include central venous pressure (CVP) and central venous oxygen saturation (ScvO₂) monitoring, administration of intravenous fluid to achieve CVP of 8 to 12 mmHg, administration of vasopressors, transfusion of red cells (RBC), and administration of inotropes. This prospective observational study aims to determine the impact of complying with each of these six EGDT elements.

Methods

The study included patients with severe sepsis/septic shock treated in our ICU. We collected demographics and the Acute Physiology and Chronic Health Evaluation III probability of death, compliance with each of the six EGDT elements within 6 hours of severe sepsis/septic shock onset and hospital mortality. The probability of hospital death at ICU admission, sepsis stage (severe or shock), and compliance with each EGDT element were entered into a multivariate logistic regression model. P < 0.05 was considered statistically significant.

Results

Excluding 31 patients who did not authorize the research, 530 patients, 355 (67%) with septic shock, were included in the study. The compliance rates with the six elements were: inotrope use 50%, ScvO₂measurement 60%, adequate fluid resuscitation 69%, RBC transfusion 83%, CVP monitoring 83%, and vaso-pressor use 89%. The observed and predicted hospital rates were 33% and 36%, respectively. Shock (odds ratio (OR), 95% confidence interval (CI) = 2.13, 1.27 to 3.58; P = 0.004) and predicted mortality (%) (OR, 95% CI = 1.04, 1.03 to 1.05; P < 0.001) and compliance with use of vasoactive drugs (OR, 95% CI = 2.93, 1.25 to 6.86; P = 0.013) were independently associated with mortality. There was no independent association between hospital mortality and inotrope use, ScvO₂, adequate fluid resuscitation, RBC transfusion, and CVP monitoring.

Conclusion

Compliance with vasopressor use of EGDT may not improve survival in severe sepsis/septic shock. Further studies are needed to determine which elements of EGDT improve outcome.