Rosado Vera, Pérez Lisandra, Guerra Héctor, Hernández Ricardo, Magraner Miguel, Bredy Rafael
Internal Medicine Residency Program, Damas Hospital, Ponce School of Medicine, Ponce, Puerto Rico.
Bol Asoc Med P R. 2011 Apr-Jun;103(2):35-8.
Severe sepsis and septic shock have become one of the leading causes of medical intensive care unit (MICU) mortality as well as one of the greater consumers of healthcare resources. Several institutions in the United States have reported positive outcomes after following the Severe Sepsis Campaign (SSC) recommendations. Current management of severe sepsis and septic shock at Damas Hospital's MICU follows no specific protocols or recommendations. This study report data regarding outcomes associated with ongoing management of severe sepsis at our institution.
Historical controls with ICD-9 diagnosis of Severe Sepsis and/or Septic Shock hospitalized between January 2007 and August 2009 were randomly selected. Data regarding survival, length of stay (ICU/ In-hospital), and disease severity was gathered through record review. Measured outcomes as well as sociodemographic data were compared to those reported in the literature.
Thirty patients were studied with a mean age of 62 years; 50% male and 50% female. Mean APACHE II score was 21 (40% mortality) with average MICU length of stay of 5.2 days and overall hospital stay of 12.9 days. Overall mortality was 66%.
There is a high mortality rate associated with conventional management of severely septic patients in Damas Hospital ICU. Studies with similar populations had significantly lower mortality rates based on conventional management of severe sepsis/septic shock. Starting protocoled care of patients with severe sepsis as recommended by the SSC could have a positive impact in the overall mortality at Damas Hospital.
严重脓毒症和脓毒性休克已成为医学重症监护病房（MICU）死亡的主要原因之一，也是医疗资源的较大消耗者之一。美国的几家机构报告称，遵循严重脓毒症运动（SSC）的建议后取得了积极成果。大马士革医院MICU目前对严重脓毒症和脓毒性休克的管理没有遵循特定的方案或建议。本研究报告了我院严重脓毒症持续管理相关的结果数据。
随机选择2007年1月至2009年8月间因ICD-9诊断为严重脓毒症和/或脓毒性休克而住院的历史对照患者。通过病历审查收集有关生存、住院时间（ICU/住院）和疾病严重程度的数据。将测量结果以及社会人口统计学数据与文献中报道的数据进行比较。
研究了30例患者，平均年龄62岁；男性和女性各占50%。平均急性生理与慢性健康状况评分系统（APACHE II）评分为21分（死亡率40%），MICU平均住院时间为5.2天，总体住院时间为12.9天。总体死亡率为66%。
大马士革医院ICU对严重脓毒症患者的传统管理死亡率较高。基于严重脓毒症/脓毒性休克的传统管理，类似人群的研究死亡率明显较低。按照SSC的建议对严重脓毒症患者开始实施规范化治疗可能会对大马士革医院的总体死亡率产生积极影响。
