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      Hemodynamic monitoring in severe sepsis and septic shock in German ICUs

      abstract
      1 , 2
      Critical Care
      BioMed Central
      26th International Symposium on Intensive Care and Emergency Medicine
      21-24 March 2006

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          Abstract

          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 [1]. 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 [2], 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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          Author and article information

          Conference
          Crit Care
          Crit Care
          Critical Care
          BioMed Central
          1364-8535
          1466-609X
          2006
          21 March 2006
          : 10
          : Suppl 1
          : P349
          Affiliations
          [1 ]Zentralsklinikum, Augsburg, Germany
          [2 ]Leipzig University, Leipzig, Germany
          Article
          cc4696
          10.1186/cc4696
          4092724
          98d11273-a309-4d40-b560-dff81cfd4060
          Copyright © 2006 BioMed Central Ltd
          26th International Symposium on Intensive Care and Emergency Medicine
          Brussels, Belgium
          21-24 March 2006
          History
          Categories
          Poster Presentation

          Emergency medicine & Trauma
          Emergency medicine & Trauma

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