Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock

RESUSCITATION

卷:82

Article

Puskarich, Michael A.²  Trzeciak, Stephen³  Shapiro, Nathan I.^4,5  Heffner, Alan C.²  Kline, Jeffrey A.²  Jones, Alan E.^1,2 

[1] Univ Mississippi, Med Ctr, Dept Emergency Med, Jackson, MS 39216 USA

[2] Carolinas Med Ctr, Dept Emergency Med, Charlotte, NC 28203 USA

[3] Cooper Univ Hosp, Div Crit Care Med & Emergency Med, Dept Med, Camden, NJ USA

[4] Beth Israel Deaconess Med Ctr, Dept Emergency Med, Boston, MA 02215 USA

[5] Beth Israel Deaconess Med Ctr, Vasc Biol Res Ctr, Boston, MA 02215 USA

关键词: Sepsis;    Septic shock;    Lactate;    Resuscitation;    Mortality;   

DOI  :  10.1016/j.resuscitation.2011.06.015

来源: Elsevier

【 摘 要 】

Introduction: We sought to compare the outcomes of patients with cryptic versus overt shock treated with an emergency department (ED) based early sepsis resuscitation protocol. Methods: Pre-planned secondary analysis of a large, multicenter ED-based randomized controlled trial of early sepsis resuscitation. All subjects were treated with a quantitative resuscitation protocol in the ED targeting 3 physiological variables: central venous pressure, mean arterial pressure and either central venous oxygen saturation or lactate clearance. The study protocol was continued until all endpoints were achieved or a maximum of 6 h. Outcomes data of patients who were enrolled with a lactate >= 4 mmol/L and normotension (cryptic shock) were compared to those enrolled with sustained hypotension after fluid challenge (overt shock). The primary outcome was in-hospital mortality. Results: A total of 300 subjects were enrolled, 53 in the cryptic shock group and 247 in the overt shock group. The demographics and baseline characteristics were similar between the groups. The primary endpoint of in-hospital mortality was observed in 11/53 (20%, 95% CI 11-34) in the cryptic shock group and 48/247 (19%, 95% CI 15-25) in the overt shock group, difference of 1% (95% CI -10 to 14: log rank test p = 0.81). Conclusion: Severe sepsis with cryptic shock carries a mortality rate not significantly different from that of overt septic shock. These data suggest the need for early aggressive screening for and treatment of patients with an elevated serum lactate in the absence of hypotension. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

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