Sir Charles Gairdner Hospital, Perth, Australia.
Sir Charles Gairdner Hospital, Perth, Australia; University of Western, Australia.
Aust Crit Care. 2022 Jul;35(4):450-453. doi: 10.1016/j.aucc.2021.06.003. Epub 2021 Jul 26.
Sepsis-related hypotension in hospital patients is a common reason for rapid response team (RRT) attendance and transfer to intensive care, but little is known about the duration and management of hypotension during these RRT call-outs.
We aimed to describe the duration and management of hypotension during RRT call-outs to patients with sepsis-related hypotension who required transfer to intensive care.
RRT call-outs during 2018 for hypotension with transfer to intensive care were identified from a prospectively maintained database of RRT call-outs at a single tertiary hospital. From these, the records of a random sample of 60 cases were reviewed, and those attributed to sepsis and without missing data were described. Hypotension was defined as systolic blood pressure < 90 mmHg.
There were 117 RRT call-outs for hypotension with transfer to intensive care, and of the 60 cases randomly chosen for further review, 41 were deemed sepsis related and were not missing data. The average age of the patients was 62 years, and 18 (44%) were already receiving antibiotics. The median time to arrival in the intensive care unit was 47 minutes. Patients were hypotensive for approximately two-thirds of their RRT time, despite 88% receiving some initial resuscitative treatments (fluids and/or vasopressors). Thirty-two (78%) were treated with intravenous fluids, and 20 (49%), with vasopressors. Patients spent 3 [2-4] days in intensive care, and 7 (17%) died in hospital.
Patients with sepsis-related hypotension requiring an RRT call and transfer to intensive care remain hypotensive for a substantial duration of the call. This concept of adequacy of resuscitation after rapid response calls needs further exploration in a larger study.
医院中与脓毒症相关的低血压是快速反应团队（RRT）出勤和转至重症监护病房的常见原因，但对于这些 RRT 呼叫中低血压的持续时间和管理知之甚少。
我们旨在描述需要转至重症监护病房的与脓毒症相关低血压患者的 RRT 呼叫中低血压的持续时间和管理。
从一家三级医院前瞻性维护的 RRT 呼叫数据库中确定了 2018 年因低血压且需要转至重症监护病房的 RRT 呼叫。从这些呼叫中，回顾了随机抽取的 60 例病例记录，并且对那些归因于脓毒症且无缺失数据的记录进行了描述。低血压定义为收缩压 < 90mmHg。
有 117 次 RRT 呼叫是为低血压且需要转至重症监护病房，在随机选择的 60 例进一步审查的病例中，有 41 例被认为与脓毒症有关且无缺失数据。患者的平均年龄为 62 岁，有 18 例（44%）已经接受了抗生素治疗。到达重症监护病房的中位数时间为 47 分钟。尽管 88%的患者接受了一些初始复苏治疗（液体和/或血管加压药），但患者在 RRT 期间仍有约三分之二的时间处于低血压状态。32 例（78%）接受了静脉补液治疗，20 例（49%）接受了血管加压药治疗。患者在重症监护病房中度过了 3 [2-4] 天，有 7 例（17%）在医院死亡。
需要 RRT 呼叫和转至重症监护病房的与脓毒症相关低血压患者在呼叫期间仍会持续低血压很长一段时间。在一项更大的研究中，需要进一步探讨快速反应呼叫后复苏的充分性这一概念。
