Antibiotics has more impact on mortality than other early goal-directed therapy components in patients with sepsis: An instrumental variable analysis / Jessica María Londoño Agudelo ; Andrea Yiseth Archila León ; Diana Patricia Cárdenas Cuervo ; Mayla Andrea Perdomo Amar ; Jairo Giovanni Moncayo Viveros  

Público ISBD Título : Antibiotics has more impact on mortality than other early goal-directed therapy components in patients with sepsis: An instrumental variable analysis Tipo de documento : documento electrónico Autores : Jessica María Londoño Agudelo, ; Andrea Yiseth Archila León, ; Diana Patricia Cárdenas Cuervo, ; Mayla Andrea Perdomo Amar, ; Jairo Giovanni Moncayo Viveros, Fecha de publicación : 2018 Títulos uniformes : Journal of Critical Care Idioma : Inglés (eng) Palabras clave : Sepsis  resuscitation  lactic acid  antibiotics  shock  hyperlactatemia Resumen : Purpose: To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality. Methods: Prospective cohort in three hospitals. Adult patients admitted by the Emergency Rooms (ER) with infection and any of systolic blood pressure b 90 mmHg or lactate N4 mmol/L. An instrumental analysis with hospital of admission as the instrumental variable was performed to estimate the effect of each intervention on hospital mortality and secondary outcomes. Results: Among 2587 patients evaluated 884 met inclusion criteria, with a hospital mortality rate of 17% (n =150). In the instrumental analysis, the only intervention associated with an absolute reduction in mortality (21%) was the use of antibiotics in the first 3 h. In patients with lactate values ≥4 mmol/L in the ER, a nondecrease of at least 10% at six hours was independently associated with mortality (OR = 3.1; 95%CI = 1.5–6.2). Conclusions: Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3 h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia N4 mmol/L, the clearance of N10% of lactate during resuscitation is associated with better outcomes. Mención de responsabilidad : Jessica Londoño, César Niño, Andrea Archila, Marta Valencia, Diana Cárdenas, Mayla Perdomo, Giovanny Moncayo, César Vargas, Carlos E Vallejo, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes Referencia : J Crit Care. 2018 Dec;48:191-197. DOI (Digital Object Identifier) : 10.1016/j.jcrc.2018.08.035 PMID : 30218959 En línea : https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(18)30531-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4175 Antibiotics has more impact on mortality than other early goal-directed therapy components in patients with sepsis: An instrumental variable analysis [documento electrónico] / Jessica María Londoño Agudelo, ; Andrea Yiseth Archila León, ; Diana Patricia Cárdenas Cuervo, ; Mayla Andrea Perdomo Amar, ; Jairo Giovanni Moncayo Viveros,  . - 2018. Obra : Journal of Critical Care Idioma : Inglés (eng) Palabras clave : Sepsis  resuscitation  lactic acid  antibiotics  shock  hyperlactatemia Resumen : Purpose: To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality. Methods: Prospective cohort in three hospitals. Adult patients admitted by the Emergency Rooms (ER) with infection and any of systolic blood pressure b 90 mmHg or lactate N4 mmol/L. An instrumental analysis with hospital of admission as the instrumental variable was performed to estimate the effect of each intervention on hospital mortality and secondary outcomes. Results: Among 2587 patients evaluated 884 met inclusion criteria, with a hospital mortality rate of 17% (n =150). In the instrumental analysis, the only intervention associated with an absolute reduction in mortality (21%) was the use of antibiotics in the first 3 h. In patients with lactate values ≥4 mmol/L in the ER, a nondecrease of at least 10% at six hours was independently associated with mortality (OR = 3.1; 95%CI = 1.5–6.2). Conclusions: Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3 h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia N4 mmol/L, the clearance of N10% of lactate during resuscitation is associated with better outcomes. Mención de responsabilidad : Jessica Londoño, César Niño, Andrea Archila, Marta Valencia, Diana Cárdenas, Mayla Perdomo, Giovanny Moncayo, César Vargas, Carlos E Vallejo, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes Referencia : J Crit Care. 2018 Dec;48:191-197. DOI (Digital Object Identifier) : 10.1016/j.jcrc.2018.08.035 PMID : 30218959 En línea : https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(18)30531-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4175

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Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality / Jessica María Londoño Agudelo ; Elisa Bernal Sierra ; Fabián Alberto Jaimes Barragán  

Público ISBD Título : Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality Tipo de documento : documento electrónico Autores : Jessica María Londoño Agudelo, ; Elisa Bernal Sierra, ; Fabián Alberto Jaimes Barragán, Fecha de publicación : 2018 Títulos uniformes : Shock Idioma : Inglés (eng) Palabras clave : Hyperlactatemia  lactic acid  multiple trauma  oxygen consumption  patient outcome assessment  resuscitation  sepsis  shock  vasopressors Resumen : Background: Lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination may replace it as screening tool. We have determined the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 h of resuscitation; and the association between clinical parameters, lactate, and mortality. Methods: Prospective cohort study of adult patients hospitalized in the emergency room with infection, polytrauma, or other causes of hypotension. We measured serum lactate, capillary refill time, shock index, and pulse pressure at 0, 6, and 24 h after admission. A Spearman's correlation was performed between clinical variables and lactate levels, as well as between changes in clinical parameters and lactate clearance. The operative characteristics of these variables were determined by area under the receiver operating characteristic curve analysis and the association between lactate, clinical variables, and mortality through logistic regression. Results: A total of 1,320 patients met the inclusion criteria, 66.7% (n = 880) confirmed infection, 19% (n = 251) polytrauma, and 14.3% (n = 189) another etiology. No significant correlation was found between any clinical variable and lactate values (r Mención de responsabilidad : Jessica Londoño, César Niño, James Díaz, Carlos Morales, Jimmy León, Elisa Bernal, Cesar Vargas, Leonardo Mejía, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes Referencia : Shock. 2018 Sep;50(3):286-292. DOI (Digital Object Identifier) : 10.1097/SHK.0000000000001066 PMID : 29206763 En línea : https://journals.lww.com/shockjournal/fulltext/2018/09000/Association_of_Clinica [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4199 Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality [documento electrónico] / Jessica María Londoño Agudelo, ; Elisa Bernal Sierra, ; Fabián Alberto Jaimes Barragán,  . - 2018. Obra : Shock Idioma : Inglés (eng) Palabras clave : Hyperlactatemia  lactic acid  multiple trauma  oxygen consumption  patient outcome assessment  resuscitation  sepsis  shock  vasopressors Resumen : Background: Lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination may replace it as screening tool. We have determined the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 h of resuscitation; and the association between clinical parameters, lactate, and mortality. Methods: Prospective cohort study of adult patients hospitalized in the emergency room with infection, polytrauma, or other causes of hypotension. We measured serum lactate, capillary refill time, shock index, and pulse pressure at 0, 6, and 24 h after admission. A Spearman's correlation was performed between clinical variables and lactate levels, as well as between changes in clinical parameters and lactate clearance. The operative characteristics of these variables were determined by area under the receiver operating characteristic curve analysis and the association between lactate, clinical variables, and mortality through logistic regression. Results: A total of 1,320 patients met the inclusion criteria, 66.7% (n = 880) confirmed infection, 19% (n = 251) polytrauma, and 14.3% (n = 189) another etiology. No significant correlation was found between any clinical variable and lactate values (r Mención de responsabilidad : Jessica Londoño, César Niño, James Díaz, Carlos Morales, Jimmy León, Elisa Bernal, Cesar Vargas, Leonardo Mejía, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes Referencia : Shock. 2018 Sep;50(3):286-292. DOI (Digital Object Identifier) : 10.1097/SHK.0000000000001066 PMID : 29206763 En línea : https://journals.lww.com/shockjournal/fulltext/2018/09000/Association_of_Clinica [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4199

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