Early goal directed therapy in severe sepsis and septic shock patient: Can CVP measurement replaced by IVC Ultrasound?
Keywords:
severe sepsis, septic shock, UltrasoundAbstract
Introduction : Previous studies in other countries comparing treatment of severe sepsis or septic shock according to early goal-directed therapy (EGDT) protocol to usual care yielded no difference in 90-day mortality. Nevertheless, the information on the method of fluid assessment in these studies was not provided. Also, there are currently no similar studies according to Thailand's emergency patients' context, which have different technology and equipment.
Objectives : To compare in-hospital mortality rate between patients diagnosed with severe sepsis or septic shock receiving non-invasive fluid assessment by non-invasive ultrasonography protocol to those receiving invasive central venous pressure measurement.
Methods : Retrospective cohort technique was used in this study, comparing emergency patients in Maharaj Nakorn Chiang Mai hospital with severe sepsis or septic shock treated according to EGDT protocol with fluid assessment using invasive central venous pres-sure measurement and those using non-invasive ultrasonography protocol. The primary outcome of the study was in-hospital mortality rate. The secondary outcomes were length of hospital stay and complications.
Results : During the data collection period from February to October 2015, there were 87 patients diagnosed with severe sepsis or septic shock admitted to inpatient departments. 79 patients were included into the study. 49 patients were treated according to EGDT protocol, while 30 patients were treated by non-invasive ultrasonography protocol. There were no significant differences between the two groups in term of in-hospital mortality rate, length of hospital stays, and no complications were found.
Conclusion : In hospital mortality rate in patients diagnosed with severe sepsis or septic shock were not significantly different between patients receiving non-invasive fluid assessment by non-invasive ultrasonography protocol and those receiving invasive central venous pressure measurement.
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