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