An evidence-based resuscitation algorithm applied from the emergency room to the ICU improves survival of severe septic shock

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dc.catalogadorpau
dc.contributor.authorCastro López, Ricardo
dc.contributor.authorRegueira Heskia, Tomás
dc.contributor.authorAguirre Zúniga, Marcia Lorena
dc.contributor.authorLlanos Valdés, Osvaldo Pablo
dc.contributor.authorBruhn, Alejandro
dc.contributor.authorBugedo Tarraza, Guillermo
dc.contributor.authorDougnac Labatut, Alberto
dc.contributor.authorCastillo Fuenzalida, Luis Benito
dc.contributor.authorAndresen Hernández, Max
dc.contributor.authorHernández P., Glenn
dc.date.accessioned2023-05-18T19:49:36Z
dc.date.available2023-05-18T19:49:36Z
dc.date.issued2008
dc.description.abstractBackground. Septic shock is highly lethal. We recently implemented an algorithm (advanced resuscitation algorithm for septic shock, ARAS 1) with a global survival of 67%, but with a very high mortality (72%) in severe cases [norepinephrine (NE) requirements >0.3 µg/kg/min for mean arterial pressure ≥70 mmHg]. As new therapies with different levels of evidence were proposed [steroids, drotrecogin alpha, high-volume hemofiltration (HVHF)], we incorporated them according to severity (NE requirements; algorithm ARAS-2), and constructed a multidisciplinary team to manage these patients from the emergency room (ER) to the ICU. The aim of this study was to compare the outcome of severe septic shock patients under both protocols. Methods. Adult patients with severe septic shock were enrolled consecutively and managed prospectively with ARAS1 (1999-2001), and ARAS-2 (2002-05). ARAS-2 incorporates HVHF for intractable shock. Results. Thirty-three patients were managed with each protocol, without statistical differences in baseline demographics, APACHE II (22.2 vs 23.8), SOFA (11.4 vs 12.7) and NE peak levels (0.62 vs 0.8 µg/kg/min). The 28-day mortality and epinephrine use were higher with ARAS-1 (72.7% vs 48.5%; 87.9% vs 18.2 %); and low-dose steroids (35.9% vs 72.7%), drotrecogin (0 vs 15 %) and HVHF use (3.0% vs 39.4%) were higher for ARAS-2 (P<0.05 for all). Conclusion. Management of severe septic shock with a multidisciplinary team and an updated protocol (according to the best current evidence), with precise entry criteria for every intervention at different stages of severity, may improve survival in these patients. Multidisciplinary management, rationalization of the use of vasoactives and rescue therapy based on HVHF instead of epinephrine may have contributed to these results. Management of severe septic shock with these kinds of algorithms is feasible and should be encouraged.
dc.format.extent9 páginas
dc.fuente.origenORCID
dc.identifier.issn0375-9393
dc.identifier.urihttp://www.scopus.com/inward/record.url?eid=2-s2.0-47849093761&partnerID=MN8TOARS
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/67061
dc.information.autorucEscuela de Medicina; Castro López, Ricardo; 0000-0002-0978-9891; 4537
dc.information.autorucEscuela de Medicina; Regueira Heskia, Tomás; S/I; 18434
dc.information.autorucEscuela de Medicina; Aguirre Zúniga, Marcia Lorena; S/I; 152804
dc.information.autorucEscuela de Medicina; Llanos Valdés, Osvaldo Pablo; S/I; 70010
dc.information.autorucEscuela de Medicina; Bruhn, Alejandro; 0000-0001-8034-1937; 741
dc.information.autorucEscuela de Medicina; Bugedo Tarraza, Guillermo; 0000-0001-7527-6202; 60490
dc.information.autorucEscuela de Medicina; Dougnac Labatut, Alberto; S/I; 54554
dc.information.autorucEscuela de Medicina; Castillo Fuenzalida, Luis Benito; S/I; 54397
dc.information.autorucEscuela de Medicina; Andresen Hernández, Max; 0000-0003-1874-1416; 54274
dc.information.autorucEscuela de Medicina; Hernández P., Glenn; S/I; 98874
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final231
dc.pagina.inicio223
dc.revistaMinerva Anestesiológica
dc.rightsacceso abierto
dc.subjectShock
dc.subjectSeptic
dc.subjectSepsis
dc.subjectAlgorithms
dc.subjectNorepinephrine
dc.subjectEpinephrine
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleAn evidence-based resuscitation algorithm applied from the emergency room to the ICU improves survival of severe septic shock
dc.typeartículo
dc.volumen74
sipa.codpersvinculados4537
sipa.codpersvinculados18434
sipa.codpersvinculados152804
sipa.codpersvinculados70010
sipa.codpersvinculados741
sipa.codpersvinculados60490
sipa.codpersvinculados54554
sipa.codpersvinculados54397
sipa.codpersvinculados54274
sipa.codpersvinculados98874
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