脓毒症诱发低血压最初3小时内的复苏情况因患者和医院因素而异。

Resuscitation in the First 3 Hours of Sepsis-Induced Hypotension Varies by Patient and Hospital Factors.

作者信息

Chen Jen-Ting, Roberts Russel J, Sevransky Jonathan Eliot, Gong Michelle Ng

机构信息

Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.

出版信息

Crit Care Explor. 2023 Feb 6;5(2):e0859. doi: 10.1097/CCE.0000000000000859. eCollection 2023 Feb.

DOI:10.1097/CCE.0000000000000859

PMID:36778909

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9904767/

Abstract

UNLABELLED

Patient and hospital factors affects how we resuscitate patients in the first 3 hours of sepsis-induced hypotension.

OBJECTIVES

To evaluate variability in compliance to the 3-hour surviving sepsis campaign (SSC) bundle and explore the association of early compliance with subsequent shock and in-hospital mortality.

DESIGN

Retrospective cohort study between September 2017 and February 2018.

SETTING

Thirty-four academic medical centers.

PARTICIPANTS

A subgroup sepsis-induced hypotensive patients from a larger shock cohort study.

MAIN OUTCOMES AND MEASURES

Compliance to SSC bundle that was defined as receiving appropriate antibiotics, 30 mL/kg of crystalloid or initiation of vasopressors, and lactate, obtained in the first 3 hours following sepsis-induced hypotension.

RESULTS

We included 977 patients with septic-induced hypotension. Bundle compliance was 43.8%, with the lowest compliance to fluid or vasopressor components (56%). Patients with high Sequential Organ Failure Assessment scores and physiologic assessments were more likely to receive compliant care, as were patients with sepsis-induced hypotension onset in the emergency department (ED) or admitted to mixed medical-surgical ICUs. SSC compliance was not associated with in-hospital mortality (adjusted odds ratio, 0.72; 95% CI, 0.47-1.10). The site-to-site variability contributed to SSC compliance (intraclass correlation coefficient [ICC], 0.15; 95% CI, 0.07-0.3) but not in-hospital mortality (ICC, 0.02; 95% CI, 0.001-0.24). Most patients remained in shock after 3 hours of resuscitation (SSC compliant 81.1% and noncompliant 53.7%). Mortality was higher among patients who were persistently hypotensive after 3 hours of resuscitation for both the SSC compliant (persistent hypotension 37% vs not hypotensive 27.2%; = 0.094) and noncompliant (30.1% vs 18.2%; = 0.001, respectively).

CONCLUSIONS AND RELEVANCE

Patients with a higher severity of illness and sepsis-induced hypotension identified in the ED were more likely to receive SSC-compliant care. SSC compliance was not associated with in-hospital mortality after adjusting for patient- and hospital-level differences. Higher mortality is seen among those who remain in shock after initial resuscitation, regardless of SSC compliance.

摘要

未标注

患者因素和医院因素会影响我们在脓毒症诱发低血压的最初3小时内对患者进行复苏的方式。

目的

评估对“拯救脓毒症运动（SSC）”集束治疗的依从性差异，并探讨早期依从性与后续休克及院内死亡率之间的关联。

设计

2017年9月至2018年2月的回顾性队列研究。

地点

34家学术医疗中心。

参与者

来自一项更大规模休克队列研究的脓毒症诱发低血压患者亚组。

主要结局和测量指标

对SSC集束治疗的依从性，定义为在脓毒症诱发低血压后的最初3小时内接受适当的抗生素、30 mL/kg晶体液或启动血管升压药治疗，以及检测乳酸水平。

结果

我们纳入了977例脓毒症诱发低血压患者。集束治疗的依从率为43.8%，对液体或血管升压药部分的依从率最低（56%）。序贯器官衰竭评估评分高和生理评估结果高的患者更有可能接受符合要求的治疗，在急诊科发生脓毒症诱发低血压或入住内科-外科混合重症监护病房的患者也是如此。SSC依从性与院内死亡率无关（校正比值比，0.72；95%置信区间，0.47 - 1.10）。各中心之间的差异对SSC依从性有影响（组内相关系数[ICC]，0.15；95%置信区间，0.07 - 0.3），但对院内死亡率没有影响（ICC，0.02；95%置信区间，0.001 - 0.24）。大多数患者在复苏3小时后仍处于休克状态（SSC依从组为81.1%，不依从组为53.7%）。在复苏3小时后仍持续低血压的患者中，死亡率更高，无论是SSC依从组（持续低血压37% vs 非低血压27.2%；P = 0.094）还是不依从组（分别为30.1% vs 18.2%；P = 0.001）。