tailieunhanh - Báo cáo y học: "The outcomes of severe sepsis and septic shock in the UK"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: The outcomes of severe sepsis and septic shock in the UK. | Available online http content 10 4 417 Letter The outcomes of severe sepsis and septic shock in the UK Adam D Reuben Andrew V Appelboam and Ian Higginson Derriford Hospital Plymouth UK Corresponding author Adam D Reuben adamreuben@ Published 27 July 2006 This article is online at http content 10 4 417 2006 BioMed Central Ltd See related research by Ho et al. http content 10 3 R80 Critical Care 2006 10 417 doi ee4966 We read with considerable interest the recent article by Ho and coworkers 1 . We welcome the attention that this brings to the emergency department ED management of septic patients and congratulate them on their aggressive management approach in the absence of a formal protocol for goal-directed therapy. There is now good evidence to show that protocols such as that described by Rivers and coworkers 2 can reliably be implemented in clinical practice 3-5 although their results in terms of mortality benefit are yet to be reproduced. We like the authors have recently carried out an activity analysis of patients admitted through the ED in an attempt to quantify the size of the problem in a large UK teaching hospital. We identified patients who presented to the ED at Derriford Hospital Plymouth who were afforded an infectious diagnosis over a 12-month period from August 2004 to July 2005. Patients who would have fulfilled the criteria for goal-directed therapy were identified by review of ED databases stored blood gas databases review of local ICNARC Intensive Care National Audit Research Centre data and by hand searching of notes. Of a total of 83 324 ED attendances 2224 had an infective diagnosis attributed to them and of these 75 patients had a final diagnosis of severe sepsis or septic shock of whom 32 43 died. Of the 75 patients 38 51 were admitted to the intensive care unit ICU and the remaining 37 49 were admitted directly to the acute medical ward. Of the 37 patients who went to the medical ward