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Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study Ferrer R; Artigas A; Suarez D; Palencia E; Levy MM; Arenzana A; Perez XL; Sirvent JMAm J Respir Crit Care Med 2009[Nov]; 180 (9): 861-6RATIONALE: Several Surviving Sepsis Campaign Guidelines recommendations are reevaluated. OBJECTIVES: To analyze the effectiveness of treatments recommended in the sepsis guidelines. METHODS: In a prospective observational study, we studied all adult patients with severe sepsis from 77 intensive care units. We recorded compliance with four therapeutic goals (central venous pressure 8 mm Hg or greater for persistent hypotension despite fluid resuscitation and/or lactate greater than 36 mg/dl, central venous oxygen saturation 70% or greater for persistent hypotension despite fluid resuscitation and/or lactate greater than 36 mg/dl, blood glucose greater than or equal to the lower limit of normal but less than 150 mg/dl, and inspiratory plateau pressure less than 30 cm H(2)O for mechanically ventilated patients) and four treatments (early broad-spectrum antibiotics, fluid challenge in the event of hypotension and/or lactate greater than 36 mg/dl, low-dose steroids for septic shock, drotrecogin alfa [activated] for multiorgan failure). The primary outcome measure was hospital mortality. The effectiveness of each treatment was estimated using propensity scores. MEASUREMENTS AND MAIN RESULTS: Of 2,796 patients, 41.6% died before hospital discharge. Treatments associated with lower hospital mortality were early broad-spectrum antibiotic treatment (treatment within 1 hour vs. no treatment within first 6 hours of diagnosis; odds ratio, 0.67; 95% confidence interval, 0.50-0.90; P = 0.008) and drotrecogin alfa (activated) (odds ratio, 0.59; 95% confidence interval, 0.41-0.84; P = 0.004). Fluid challenge and low-dose steroids showed no benefits. CONCLUSIONS: In severe sepsis, early administration of broad-spectrum antibiotics in all patients and administration of drotrecogin alfa (activated) in the most severe patients reduce mortality.|Adrenal Cortex Hormones/*therapeutic use[MESH]|Aged[MESH]|Anti-Bacterial Agents/*therapeutic use[MESH]|Anti-Infective Agents/*therapeutic use[MESH]|Cohort Studies[MESH]|Female[MESH]|Fluid Therapy/*methods[MESH]|Follow-Up Studies[MESH]|Hospital Mortality[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Odds Ratio[MESH]|Prospective Studies[MESH]|Protein C/*therapeutic use[MESH]|Recombinant Proteins/therapeutic use[MESH]|Sepsis/drug therapy/*therapy[MESH]|Survival Analysis[MESH]|Treatment Outcome[MESH] |
