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Hemodynamic monitoring in severe sepsis and septic shock in German ICUs
Critical Care volume 10, Article number: P349 (2006)
The first-line therapy in severe sepsis and septic shock is volume resuscitation, since relative and absolute hypovolemia are key symptoms of this illness. In addition a small subset of patients present with a septic cardiomyopathy (10–15%), a type of heart failure that barely responds to inotropes. Rapid restoration of blood flow and of tissue oxygenation respectively is of utmost importance in order to prevent organ dysfunction. So it is reasonable to postulate hemodynamic monitoring to diagnose pathophysiologic features and to guide therapy in these severely ill patients; more so since it has been shown recently that a substantial reduction in mortality could be achieved following therapeutic goals .
The objective of the study was to evaluate monitoring habits in German ICUs in patients with severe sepsis and septic shock.
A prospective observational cross-sectional study was performed in the ICUs of a representative hospital sample randomly selected from a complete registry of German hospitals stratified by size (≤ 200; 201–400; 401–600; >600 beds; university hospitals). From a total of 3877 patients screened, 415 patients (11%) fulfilled the ACCP/SCCM criteria for severe sepsis or septic shock. In these patients, monitoring routines – arterial blood pressure (ABP), central venous pressure (CVP), pulmonary artery catheter (PAC) and pulse contour analysis (PCA) – were ascertained by physicians trained in critical care medicine and compared with the data of a questionnaire that had been answered by the director of the ICU.
In general there was a pronounced difference between the statements of the ICU directors answering the questionnaire and the monitoring devices actually used. Only CVP measurement had been performed in all ICU patients in all hospital strata, and there was no gap between the questionnaire and instituted device. Patients in hospitals >400 beds were monitored with invasive ABP measurement in the majority of all cases, while middle-sized hospitals did this less frequently (60–75%). The PAC had been used in only a small subset of patients (<12%), although especially in larger hospitals the ICU director stated to use it more frequently (university: 40.4%). PCA, an excellent device to guide volume resuscitation , had seldom been in use as well. Even in major hospitals less than 15% of all patients monitored their patients in this way.
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Competence Network Sepsis is funded by the BMBF Grant No: 01KI0106. Sponsored by Lilly Germany.
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Jaschinski, U., Engel, C. Hemodynamic monitoring in severe sepsis and septic shock in German ICUs. Crit Care 10 (Suppl 1), P349 (2006). https://doi.org/10.1186/cc4696