A modified goal-directed protocol improves clinical outcomes in intensive care unit patients with septic shock: A randomized controlled trial

Shu Min Lin, Chien Da Huang, Horng Chyuan Lin, Chien Ying Liu, Chun Hua Wang, Han Pin Kuo

研究成果: 雜誌貢獻文章同行評審

185 引文 斯高帕斯(Scopus)

摘要

We evaluated whether a goal-directed protocol, without measurement of central venous oxygen saturation, would improve survival in medical intensive care unit (ICU) patients with septic shock. This is a prospective, controlled study in a 24-bed medical ICU at a tertiary care hospital. From a total of 241 consecutive patients with septic shock, 224 were randomly assigned to receive therapy with or without a written protocol using central venous pressure, mean arterial pressure, and urine output as therapeutic goals. Baseline characteristics were similar between groups. Implementation of goal-directed therapy caused a more rapid reversal of persistent shock (47 ± 22.8 vs. 65.4 ± 32.1 h, P = 0.006) and decreases of ICU (50% vs. 67.2%, P = 0.009) and in-hospital (53.7% vs. 71.6%, P = 0.006) mortality rates compared with non-goal-directed therapy. Patients receiving goal-directed therapy also had less risk for developing central nervous system or renal failure than patients without. Patients with goal-directed therapy received more fluid during the period of persistent shock (136.2 ± 119 vs. 88.6 ± 57.7 mL h, P = 0.034) and less delay in vasopressor administration (78 ± 22.2 vs. 104.4 ± 29 min, P = 0.001) than patients with non-goal therapy. Implementation of a goal-directed protocol improves survival and clinical outcomes in ICU patients with septic shock. These benefits may arise from adequate fluid resuscitation, earlier vasopressor administration, rapid shock reversal, and protection of major organ function. With central venous oxygen saturation measurement to detect tissue perfusion, the clinical outcomes may be further improved.
原文英語
頁(從 - 到)551-557
頁數7
期刊Shock
26
發行號6
DOIs
出版狀態已發佈 - 12月 1 2006
對外發佈

ASJC Scopus subject areas

  • 急診醫學
  • 重症監護和重症監護醫學

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