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首页> 外文期刊>Canadian Journal of Emergency Medicine >Effect of an emergency department sepsis protocol on the care of septic patients admitted to the intensive care unit
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Effect of an emergency department sepsis protocol on the care of septic patients admitted to the intensive care unit

机译：急诊败血症方案对重症监护病房败血症患者护理的影响

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Objective:We sought to determine whether the implementation of a sepsis protocol in a Canadian emergency department (ED) improves care for the subset of patients admitted to the intensive care unit (ICU).Methods:After implementing a sepsis protocol in our ED we used an ICU database and chart review to compare various time-dependent end points and outcomes between a historical control year and the first year after implementation. We reviewed the charts of all patients admitted to the ICU within 24 hours of ED admission with a primary or other diagnosis of sepsis, severe sepsis or septic shock, who met criteria for early goal-directed therapy within the first 6 hours of their ED stay.Results:We compared 29 patients from the control year with 30 patients from the year after implementation of our sepsis protocol. We found that patients treated during the postintervention year had improvements in time to antibiotics (4.2 v. 1.0 h, difference = –3.2 h, 95% CI –4.8 to –2.0), time to central line placement (above the diaphragm) (11.6 v. 3.2 h, difference = –8.4 h, 95% CI –12.1 to –4.7), time to arterial line placement (7.5 v. 2.3 h, difference = –5.2 h, 95% CI –7.4 to –3.0), and achievement of central venous pressure and central venous oxygen saturation goals (11.1 v. 5.1 h, difference = –6.0 h, 95% CI –11.03 to –1.71, and 13.1 v. 5.5 h, difference = –7.6 h, 95% CI –11.97 to –3.16, respectively). There were no statistically significant differences in ICU length of stay, hospital length of stay or mortality (31.0% v. 20.0%, difference = –11.0%, 95% CI –33.1% to 11.1%).Conclusion:Implementation of an ED sepsis protocol improves care for patients with severe sepsis and septic shock.
机译：目的：我们试图确定在加拿大急诊科（ED）中实施败血症方案是否能改善重症监护病房（ICU）住院患者的亚型。方法：在我们的ED中实施败血症方案后，我们使用了ICU数据库和图表审查，以比较历史控制年与实施后第一年之间各种时间相关的终点和结果。我们回顾了所有在ED入院24小时内入院ICU的患者，其主要或其他诊断为败血症，严重败血症或败血性休克的图表，这些患者在ED住院的前6个小时内符合早期目标导向治疗的标准结果：我们比较了控制年的29例患者和实施败血症方案后的30例患者。我们发现在干预后的一年中接受治疗的患者在使用抗生素的时间（4.2 v。1.0 h，差异= –3.2 h，95％CI –4.8-–2.0），中心线放置时间（隔膜上方）方面有所改善（11.6） v。3.2小时，差异= –8.4小时，95％CI –12.1至–4.7），放置动脉的时间（7.5 v。2.3 h，差异= –5.2 h，95％CI –7.4至–3.0），和达到中心静脉压和中心静脉血氧饱和度目标（11.1 v。5.1 h，差异= –6.0 h，95％CI –11.03至–1.71，以及13.1 v。5.5 h，差异= –7.6 h，95％CI –分别为11.97至–3.16）。 ICU住院时间，住院时间或死亡率无统计学差异（31.0％对20.0％，差异= –11.0％，95％CI –33.1％至11.1％）。结论：ED败血症的发生该协议改善了严重脓毒症和脓毒性休克患者的护理。

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