Early Infection Therapy Reduces ICU Mortality

A study has found that patients given aggressive treatment for severe sepsis and septic shock in the emergency department (ED) in the first six hours before admission to the intensive care unit (ICU) have lower death rates, less risk of organ failure, and spend less time in the hospital. Conducted by researchers at the Henry Ford Hospital (Detroit, MI, USA), the study was published in the November 8, 2001, issue of The New England Journal of Medicine.

The study involved 263 patients, of whom 133 were treated with standard care and 130 with an aggressive intervention called early goal-directed therapy (EGDT). Treatment in the EGDT group was guided by an eight-inch fiber optic catheter inserted into the heart to detect decreases in oxygen delivery to vital organs. Patients in this group received fluid and heart medications. Patients in the other group received routine treatment base on physical exam, vital signs, blood pressure, and urine output. They also received a standard catheter inserted in the heart to measure blood pressure instead of blood oxygen levels.

Patients in the EGDT group had a mortality rate of 30.5%, compared to 46.5% in the standard care group. The EGDT group also had a substantially lower incidence of organ failure and spent less time in the hospital. The researchers say that standard diagnostic methods fail to detect significant decreases in oxygen delivery to vital organs in the early stages of severe infection. Severe sepsis and septic shock account for as many deaths every year as heart attacks in the United States.

"The treatment shown to be effective in this study is generally routine in the intensive care unit,” said Emanuel P. Rovers, M.D., director of research at Henry Ford's department of emergency medicine and the lead author of the study. "But we've shown that the treatment is even more effective when applied at earlier stages in the emergency department.




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