Australasian Resuscitation in Sepsis Evaluation study

Introduction

The role of early-goal directed therapy (EGDT) in severe sepsis (SS) is unclear. A 3-month prospective, multicentre, ANZICS CTG-endorsed observational study supported by the ANZIC Research Centre was performed to determine current resuscitation practices and outcomes in patients presenting to the emergency department (ED) with SS in 32 Australian and New Zealand (ANZ) hospitals from September 2006 to January 2007.

Methods

Adult patients with ≥ 2 systemic inflammatory response criteria and either hypotension (systolic blood pressure <90 mmHg or mean arterial pressure <65 mmHg after a 500 ml fluid challenge or the requirement for vasoactive agents) or metabolic acidosis (blood lactate >4.0 mmol/l or anion gap >20 mEq/l) presenting to the ED were identified.

Results

Three hundred and twenty-four patients (52.5% male) of median age 66 years (IQR 50, 79) and APACHE II score 18.0 (IQR 13.0, 24.5) were enrolled. Pneumonia (42.6%) and urinary tract infection (30.2%) were the commonest causes of severe sepsis. Between T0 (enrolment) and T+6 hours, 44.4% received an intra-arterial, 37% a central venous and no patients a continuous central venous oxygen saturation catheter. Between T0 and T+6 hours, a vasoactive infusion was commenced in 30.2%, a red blood cell transfusion in 7.7%, and a dobutamine infusion in 2.5%. In the same time period, 52.6% were admitted to the ICU and 18.8% had invasive ventilation. Overall hospital mortality was 20.1% and was not different between patients admitted to the ICU (18.9%) and the general ward (20.4%).

Conclusion

The management of patients presenting to the ED with SS in ANZ does not include EGDT. Hospital mortality was lower than previously reported and the baseline mortality in ANZ was much lower than in Rivers and colleagues' trial [1]. Reliable estimates of sample size and recruitment rate for a proposed multicentre trial in ANZ were obtained, confirming that there are sufficient patient numbers to perform a randomised controlled trial in ANZ. The present observational study has resulted in a successful NHMRC grant application to fund a large multicentre trial of EGDT in SS in Australasia.