Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Icahn School of Medicine at Mount Sinai, New York, NY, United States.
J Crit Care. 2019 Jun;51:94-98. doi: 10.1016/j.jcrc.2019.02.006. Epub 2019 Feb 5.
The Surviving Sepsis Campaign and Centers for Medicare and Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) recommend rapid crystalloid infusion (≥30 mL/kg) for patients with sepsis-induced hypoperfusion or septic shock. We aimed to assess compliance with this recommendation, factors associated with non-compliance, and how compliance relates to mortality.
Retrospective, observational study.
1136-bed academic and 235-bed community hospital (January 2015-June 2016).
Patients with septic shock.
Crystalloid infusion (≥30 mL/kg) within 6 h of identification of septic shock as required by CMS.
Associations with compliance and how compliance associates with mortality; odds ratios (OR) and 95% confidence intervals (CI) reported.
Overall, 1027 septic shock patients were included. Of these, 486 (47.3%) met the 6-hour 30 ml/kg fluid requirement. Compliance was lower in patients with congestive heart failure (CHF) (40.9%), chronic kidney disease (CKD) (42.3%) or chronic liver disease (38.5%) and among those that were identified in the inpatient setting (35.4%) rather than in the emergency department (51.7%). When adjusting for relevant covariates, compliance (compared to non-compliance) was not associated with in-hospital mortality: OR 1.03 CI 0.76-1.41.
These findings question a "one-size-fits-all" approach to fluid administration and performance measures for patients with sepsis.
《拯救脓毒症运动》和联邦医疗保险和医疗补助服务中心（CMS）严重脓毒症和脓毒性休克管理捆绑包（SEP-1）建议对低灌注或脓毒性休克的脓毒症患者进行快速晶体液输注（≥30ml/kg）。我们旨在评估对该建议的遵守情况、不遵守的相关因素以及遵守情况与死亡率的关系。
回顾性观察性研究。
1136 床的学术医院和 235 床的社区医院（2015 年 1 月至 2016 年 6 月）。
脓毒性休克患者。
根据 CMS 的要求，在识别出脓毒性休克后的 6 小时内输注晶体液（≥30ml/kg）。
与合规性的关联以及合规性与死亡率的关联；报告比值比（OR）和 95%置信区间（CI）。
总体而言，纳入了 1027 例脓毒性休克患者。其中，486 例（47.3%）符合 6 小时 30ml/kg 液体需求。心力衰竭（CHF）（40.9%）、慢性肾脏病（CKD）（42.3%）或慢性肝病（38.5%）患者以及在住院环境中识别出的患者（35.4%）的合规性较低，而在急诊室（51.7%）识别出的患者的合规性较低。在校正相关协变量后，与不遵守相比，遵守（与不遵守相比）与住院死亡率无关：OR 1.03，CI 0.76-1.41。
这些发现对脓毒症患者的液体管理和绩效措施提出了一个“一刀切”的方法的质疑。
