Departments of Emergency Medicine and Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada.
CJEM. 2010 Sep;12(5):414-20. doi: 10.1017/s1481803500012562.
We sought to determine whether the implementation of a sepsis protocol in a Canadian emergency department (ED) improves care for the subset of patients admitted to the intensive care unit (ICU).
After implementing a sepsis protocol in our ED we used an ICU database and chart review to compare various time-dependent end points and outcomes between a historical control year and the first year after implementation. We re-viewed the charts of all patients admitted to the ICU within 24 hours of ED admission with a primary or other diagnosis of sepsis, severe sepsis or septic shock, who met criteria for early goal-directed therapy within the first 6 hours of their ED stay.
We compared 29 patients from the control year with 30 patients from the year after implementation of our sepsis protocol. We found that patients treated during the postintervention year had improvements in time to antibiotics (4.2 v. 1.0 h, difference = -3.2 h, 95% CI -4.8 to -2.0), time to central line placement (above the diaphragm) (11.6 v. 3.2 h, difference = -8.4 h, 95% CI -12.1 to -4.7), time to arterial line placement (7.5 v. 2.3 h, difference = -5.2 h, 95% CI -7.4 to -3.0), and achievement of central venous pressure and central venous oxygen saturation goals (11.1 v. 5.1 h, difference = -6.0 h, 95% CI -11.03 to -1.71, and 13.1 v. 5.5 h, difference = -7.6 h, 95% CI -11.97 to -3.16, respectively). There were no statistically significant differences in ICU length of stay, hospital length of stay or mortality (31.0% v. 20.0%, difference = -11.0%, 95% -33.1% to 11.1%).
Implementation of an ED sepsis protocol im-proves care for patients with severe sepsis and septic shock.
我们旨在确定加拿大急诊部（ED）中实施脓毒症方案是否能改善 ICU 收治患者的治疗效果。
在 ED 实施脓毒症方案后，我们使用 ICU 数据库和图表回顾，比较了历史对照年和方案实施后的第一年之间各种依赖时间的终点和结局。我们回顾了所有在 ED 就诊后 24 小时内因主要或其他脓毒症、严重脓毒症或感染性休克诊断而收入 ICU 的患者的病历，这些患者在 ED 期间的前 6 小时内符合早期目标导向治疗的标准。
我们比较了对照年的 29 例患者和方案实施后的一年中的 30 例患者。我们发现，在干预年后接受治疗的患者在抗生素使用时间（4.2 小时比 1.0 小时，差值=-3.2 小时，95%CI-4.8 至-2.0）、中心静脉导管（在膈肌之上）放置时间（11.6 小时比 3.2 小时，差值=-8.4 小时，95%CI-12.1 至-4.7）、动脉导管放置时间（7.5 小时比 2.3 小时，差值=-5.2 小时，95%CI-7.4 至-3.0）以及中心静脉压和中心静脉血氧饱和度目标的实现时间（11.1 小时比 5.1 小时，差值=-6.0 小时，95%CI-11.03 至-1.71，和 13.1 小时比 5.5 小时，差值=-7.6 小时，95%CI-11.97 至-3.16）方面均有改善。ICU 住院时间、住院时间或死亡率（31.0%比 20.0%，差值=-11.0%，95%CI-33.1%至 11.1%）方面无统计学差异。
ED 脓毒症方案的实施改善了严重脓毒症和感染性休克患者的治疗效果。
