Resuscitation of Septic Patients with Target-and-endpoint Protocol:A Retrospective Study from a Chinese Tertiary Hospital ICU

作     者：Hongmin Zhang Xiaoting Wang Qing Zhang Dawei Liu 

作者机构：Department of Critical Care MedicinePeking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China 

出 版 物：《Chinese Medical Sciences Journal》 (中国医学科学杂志（英文版）)

年 卷 期：2018年第33卷第3期

页      面：135-142页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：sepsis septic shock lactate central venous pressure 

摘      要：Objective To investigate the effect of target-and-endpoint protocol on the resuscitation of septic patients.Methods This is a retrospective study performed at the Peking Union Medical College Hospital Intensive Care Unit.We enrolled 545 septic patients who needed vasopressors on at least the first day of ICU admission.The general characteristics,blood lactate level,mean arterial pressure(MAP),central venous pressure(CVP)and saturation of central venous oxygen(ScvO2)at admission and 6,24 hours after admission were collected.The parameters at different time points were compared.Lactate clearance rate and in-hospital mortality were analyzed.Results The 6-hour lactate clearance rate was 21.6%(IQR,8.6%-39.0%),and in-hospital mortality was 9.4%.For patients with low CVP values(8 mm Hg,1 mm Hg=0.133 kPa)at admission,CVP increased significantly at 6 hours after admission(5.4±1.6 mm Hg vs.7.7±2.6 mm Hg,P0.001).For patients with low MAP(75 mm Hg)at admission,the MAP values increased significantly at 6 hours(64.2±7.1 mm Hg vs.82.2±13.1 mm Hg,P0.001).For patients with low ScvO2 value(70%)at admission,the ScvO2 value increased significantly at 6 hours(61.9%±7.0%vs.71.9%±7.8%,P0.001).No difference was found between the values at 6 hours and the corresponding values at 24 hours after admission.For patients with high CVP values(≥8 mm Hg)at admission,CVP decreased significantly at 6 hours(11.3±4.0 mm Hg vs.10.3±2.9 mm Hg,P0.001).For patients with high MAP(≥75 mm Hg)at admission,the MAP values decreased significantly at 6 hours(94.2±13.9 mm Hg vs.89.4±11.4 mm Hg,P0.001).For patients with high ScvO2 value(≥70%)at admission,the ScvO2 values decreased significantly at 6 hours(76.8%±4.2%vs.72.9%±7.3%,P0.001).No difference was found between the values at 6 hours and the corresponding values at 24 hours.Conclusions This study suggested that in the resuscitation of sepsis and septic shock patients in the ICU,the target values did not need to be within the“normal rangerecommended by early-goal directed therapy.The“target-and-endpointprotocol,which aimed for personalized goals,deserves more consideration.