New therapy strategies for treatment of severe sepsis and septic shock in Intensive care unit of Clinical centre in Kragujevac
INTRODUCTION Despite numerous advances in medicine, the mortality rate of severe sepsis and septic shock remains high, 30-50%. New therapy strategies include: early goaldirected therapy, fluid replacement, early and appropriate antimicrobials, source of infection control, use of corticosteroids, vas...
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| Format: | Article |
| Language: | English |
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Serbian Medical Society
2008-01-01
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| Series: | Srpski Arhiv za Celokupno Lekarstvo |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0370-8179/2008/0370-81790806248J.pdf |
| _version_ | 1818918108698509312 |
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| author | Jevđić Jasna Šurbatović Maja Drakulić-Miletić Svetlana Vukićević Vladimir |
| author_facet | Jevđić Jasna Šurbatović Maja Drakulić-Miletić Svetlana Vukićević Vladimir |
| author_sort | Jevđić Jasna |
| collection | DOAJ |
| description | INTRODUCTION Despite numerous advances in medicine, the mortality rate of severe sepsis and septic shock remains high, 30-50%. New therapy strategies include: early goaldirected therapy, fluid replacement, early and appropriate antimicrobials, source of infection control, use of corticosteroids, vasopressors and inotropic therapy, use of recombinant activated protein C, tight glucose control, low-tidal-volume mechanical ventilation. They have been shown to improve the outcomes. The adequacy and speed of treatment influence the outcome, too. OBJECTIVE The objective was to evaluate if new therapy strategies had been integrated in our routine practice. METOD Patients with severe sepsis or septic shock, who were treated in the Intensive Care Unit (ICU) over a ten-month period, were analyzed retrospectively. The descriptive epidemiological method was applied. Central venous catheterization, central venous pressure, antibiotics, fluid resuscitation, mechanical ventilation, vasopressors, corticosteroids, blood administration, deep vein thrombosis prophylaxis, stress ulcer prophylaxis, glucose control, were evaluated. RESULTS 27 patients were analyzed. Patient characteristics were: age, 49.9 years (18-77) with 30-day in-hospital mortality rate of 48.1%. All patients received broad-spectrum antibiotics. Blood cultures were obtained in 85.2% patients. Adequate antimicrobial treatment was applied to 59.3% and 74.1% patients had central venous pressure monitoring. Average central venous pressure was 8.47±5.6 mm Hg (-2- 20). Aggressive fluid therapy was given to 33.3% of the cases and 66.7% of the patients with septic shock received vasoactive drugs while 29.6% received corticosteroids. Red blood cell transfusions were applied in 59.3% of patients. All patients received stress ulcer prophylaxis, and 37% of them deep vein thrombosis prophylaxis. The average value of morning glucose was 9.11±5.03 mmol/l (3.7-22.0). 63% of patients were mechanically ventilated. Blood lactate was not determined. CONCLUSION Evidence-based clinical guidelines for management of severe sepsis and septic shock have not been implemented in a widespread, systematic way in the ICU of the Clinical Centre, Kragujevac. Institutional acceptance of this protocol, and education of clinicians may improve survivability for patients with sepsis. |
| first_indexed | 2024-12-20T00:44:43Z |
| format | Article |
| id | doaj.art-deecb8c48add4fe09167d6d167980552 |
| institution | Directory Open Access Journal |
| issn | 0370-8179 |
| language | English |
| last_indexed | 2024-12-20T00:44:43Z |
| publishDate | 2008-01-01 |
| publisher | Serbian Medical Society |
| record_format | Article |
| series | Srpski Arhiv za Celokupno Lekarstvo |
| spelling | doaj.art-deecb8c48add4fe09167d6d1679805522022-12-21T19:59:27ZengSerbian Medical SocietySrpski Arhiv za Celokupno Lekarstvo0370-81792008-01-011365-624825210.2298/SARH0806248JNew therapy strategies for treatment of severe sepsis and septic shock in Intensive care unit of Clinical centre in KragujevacJevđić JasnaŠurbatović MajaDrakulić-Miletić SvetlanaVukićević VladimirINTRODUCTION Despite numerous advances in medicine, the mortality rate of severe sepsis and septic shock remains high, 30-50%. New therapy strategies include: early goaldirected therapy, fluid replacement, early and appropriate antimicrobials, source of infection control, use of corticosteroids, vasopressors and inotropic therapy, use of recombinant activated protein C, tight glucose control, low-tidal-volume mechanical ventilation. They have been shown to improve the outcomes. The adequacy and speed of treatment influence the outcome, too. OBJECTIVE The objective was to evaluate if new therapy strategies had been integrated in our routine practice. METOD Patients with severe sepsis or septic shock, who were treated in the Intensive Care Unit (ICU) over a ten-month period, were analyzed retrospectively. The descriptive epidemiological method was applied. Central venous catheterization, central venous pressure, antibiotics, fluid resuscitation, mechanical ventilation, vasopressors, corticosteroids, blood administration, deep vein thrombosis prophylaxis, stress ulcer prophylaxis, glucose control, were evaluated. RESULTS 27 patients were analyzed. Patient characteristics were: age, 49.9 years (18-77) with 30-day in-hospital mortality rate of 48.1%. All patients received broad-spectrum antibiotics. Blood cultures were obtained in 85.2% patients. Adequate antimicrobial treatment was applied to 59.3% and 74.1% patients had central venous pressure monitoring. Average central venous pressure was 8.47±5.6 mm Hg (-2- 20). Aggressive fluid therapy was given to 33.3% of the cases and 66.7% of the patients with septic shock received vasoactive drugs while 29.6% received corticosteroids. Red blood cell transfusions were applied in 59.3% of patients. All patients received stress ulcer prophylaxis, and 37% of them deep vein thrombosis prophylaxis. The average value of morning glucose was 9.11±5.03 mmol/l (3.7-22.0). 63% of patients were mechanically ventilated. Blood lactate was not determined. CONCLUSION Evidence-based clinical guidelines for management of severe sepsis and septic shock have not been implemented in a widespread, systematic way in the ICU of the Clinical Centre, Kragujevac. Institutional acceptance of this protocol, and education of clinicians may improve survivability for patients with sepsis.http://www.doiserbia.nb.rs/img/doi/0370-8179/2008/0370-81790806248J.pdfsepsisprotocoltherapy |
| spellingShingle | Jevđić Jasna Šurbatović Maja Drakulić-Miletić Svetlana Vukićević Vladimir New therapy strategies for treatment of severe sepsis and septic shock in Intensive care unit of Clinical centre in Kragujevac Srpski Arhiv za Celokupno Lekarstvo sepsis protocol therapy |
| title | New therapy strategies for treatment of severe sepsis and septic shock in Intensive care unit of Clinical centre in Kragujevac |
| title_full | New therapy strategies for treatment of severe sepsis and septic shock in Intensive care unit of Clinical centre in Kragujevac |
| title_fullStr | New therapy strategies for treatment of severe sepsis and septic shock in Intensive care unit of Clinical centre in Kragujevac |
| title_full_unstemmed | New therapy strategies for treatment of severe sepsis and septic shock in Intensive care unit of Clinical centre in Kragujevac |
| title_short | New therapy strategies for treatment of severe sepsis and septic shock in Intensive care unit of Clinical centre in Kragujevac |
| title_sort | new therapy strategies for treatment of severe sepsis and septic shock in intensive care unit of clinical centre in kragujevac |
| topic | sepsis protocol therapy |
| url | http://www.doiserbia.nb.rs/img/doi/0370-8179/2008/0370-81790806248J.pdf |
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