Early goal-directed therapy in the management of severe sepsis/septic shock in an academic Emergency Department in Malaysia

Farina Mohd. Salleh, Shahridan Mohd. Fathil, Zulkernain Ahmad, Zuraidah Che'Man

    Research output: Contribution to journalArticle

    4 Citations (Scopus)

    Abstract

    Introduction: Early goal-directed therapy (EGDT) is a haemodynamic optimization protocol that is proven to reduce mortality in cases of severe sepsis/septic shock. Objective: The objective of this study is to determine whether EGDT can be implemented successfully in an academic hospital emergency department with the existing resources and expertise. Methods: A prospective study was conducted at Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (ED UKMMC) from March until May 2009. Sixteen patients were enrolled in this study. The patients were subjected to EGDT with the aim to achieve all defned haemodynamic endpoints within the frst 6 hours of diagnosis. Data was collected regarding achievability of these endpoints. Results: The mean age of the patients was 58.4±17.4 and the mean APACHE II score on arrival was 24.2±7.6. The diagnosis of severe sepsis was made at a mean time of 1.2±1.0 hours from the time of arrival to the emergency department. All patients successfully had a central venous line inserted within 6 hours of diagnosis and the mean time to insertion was 0.7±0.8 hour. The target CVP range was achieved within an average of 2.1±2.2 hours from diagnosis. Out of the 16 patients, 12 (87.5%) achieved the target CVP goal. All patients achieved an MAP of 65 mmHg within the frst 6 hours of diagnosis with an average time of 1 hour from time of diagnosis. Eleven (68.8%) patients successfully achieved the target central vein oxygen saturation of 70% and the mean time to achieve this goal was 1.3±0.9 hours. Mean ScvO2 achieved was 81.6±6.7. Thus, the success rate for achieving all EGDT goals within the frst 6 hours of diagnosis was 62.5% (n=10). Conclusion: This study demonstrates that EGDT can be implemented in the ED with the current resources and expertise.

    Original languageEnglish
    Pages (from-to)91-97
    Number of pages7
    JournalCritical Care and Shock
    Volume13
    Issue number3
    Publication statusPublished - Aug 2010

    Fingerprint

    Malaysia
    Septic Shock
    Hospital Emergency Service
    Sepsis
    Therapeutics
    Hemodynamics
    APACHE
    Hospital Departments
    Veins
    Prospective Studies
    Oxygen
    Mortality

    Keywords

    • Critical care
    • Early goal-directed therapy
    • Emergency Department
    • Sepsis
    • Septic shock
    • Severe sepsis

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

    Cite this

    Early goal-directed therapy in the management of severe sepsis/septic shock in an academic Emergency Department in Malaysia. / Mohd. Salleh, Farina; Mohd. Fathil, Shahridan; Ahmad, Zulkernain; Che'Man, Zuraidah.

    In: Critical Care and Shock, Vol. 13, No. 3, 08.2010, p. 91-97.

    Research output: Contribution to journalArticle

    Mohd. Salleh, Farina ; Mohd. Fathil, Shahridan ; Ahmad, Zulkernain ; Che'Man, Zuraidah. / Early goal-directed therapy in the management of severe sepsis/septic shock in an academic Emergency Department in Malaysia. In: Critical Care and Shock. 2010 ; Vol. 13, No. 3. pp. 91-97.
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    abstract = "Introduction: Early goal-directed therapy (EGDT) is a haemodynamic optimization protocol that is proven to reduce mortality in cases of severe sepsis/septic shock. Objective: The objective of this study is to determine whether EGDT can be implemented successfully in an academic hospital emergency department with the existing resources and expertise. Methods: A prospective study was conducted at Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (ED UKMMC) from March until May 2009. Sixteen patients were enrolled in this study. The patients were subjected to EGDT with the aim to achieve all defned haemodynamic endpoints within the frst 6 hours of diagnosis. Data was collected regarding achievability of these endpoints. Results: The mean age of the patients was 58.4±17.4 and the mean APACHE II score on arrival was 24.2±7.6. The diagnosis of severe sepsis was made at a mean time of 1.2±1.0 hours from the time of arrival to the emergency department. All patients successfully had a central venous line inserted within 6 hours of diagnosis and the mean time to insertion was 0.7±0.8 hour. The target CVP range was achieved within an average of 2.1±2.2 hours from diagnosis. Out of the 16 patients, 12 (87.5{\%}) achieved the target CVP goal. All patients achieved an MAP of 65 mmHg within the frst 6 hours of diagnosis with an average time of 1 hour from time of diagnosis. Eleven (68.8{\%}) patients successfully achieved the target central vein oxygen saturation of 70{\%} and the mean time to achieve this goal was 1.3±0.9 hours. Mean ScvO2 achieved was 81.6±6.7. Thus, the success rate for achieving all EGDT goals within the frst 6 hours of diagnosis was 62.5{\%} (n=10). Conclusion: This study demonstrates that EGDT can be implemented in the ED with the current resources and expertise.",
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    AB - Introduction: Early goal-directed therapy (EGDT) is a haemodynamic optimization protocol that is proven to reduce mortality in cases of severe sepsis/septic shock. Objective: The objective of this study is to determine whether EGDT can be implemented successfully in an academic hospital emergency department with the existing resources and expertise. Methods: A prospective study was conducted at Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (ED UKMMC) from March until May 2009. Sixteen patients were enrolled in this study. The patients were subjected to EGDT with the aim to achieve all defned haemodynamic endpoints within the frst 6 hours of diagnosis. Data was collected regarding achievability of these endpoints. Results: The mean age of the patients was 58.4±17.4 and the mean APACHE II score on arrival was 24.2±7.6. The diagnosis of severe sepsis was made at a mean time of 1.2±1.0 hours from the time of arrival to the emergency department. All patients successfully had a central venous line inserted within 6 hours of diagnosis and the mean time to insertion was 0.7±0.8 hour. The target CVP range was achieved within an average of 2.1±2.2 hours from diagnosis. Out of the 16 patients, 12 (87.5%) achieved the target CVP goal. All patients achieved an MAP of 65 mmHg within the frst 6 hours of diagnosis with an average time of 1 hour from time of diagnosis. Eleven (68.8%) patients successfully achieved the target central vein oxygen saturation of 70% and the mean time to achieve this goal was 1.3±0.9 hours. Mean ScvO2 achieved was 81.6±6.7. Thus, the success rate for achieving all EGDT goals within the frst 6 hours of diagnosis was 62.5% (n=10). Conclusion: This study demonstrates that EGDT can be implemented in the ED with the current resources and expertise.

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    KW - Sepsis

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    KW - Severe sepsis

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