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2012 ; 40
(7
): 2096-101
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Randomized trial of automated, electronic monitoring to facilitate early
detection of sepsis in the intensive care unit*
#MMPMID22584763
Hooper MH
; Weavind L
; Wheeler AP
; Martin JB
; Gowda SS
; Semler MW
; Hayes RM
; Albert DW
; Deane NB
; Nian H
; Mathe JL
; Nadas A
; Sztipanovits J
; Miller A
; Bernard GR
; Rice TW
Crit Care Med
2012[Jul]; 40
(7
): 2096-101
PMID22584763
show ga
OBJECTIVE: To determine whether automated identification with physician
notification of the systemic inflammatory response syndrome in medical intensive
care unit patients expedites early administration of new antibiotics or
improvement of other patient outcomes in patients with sepsis. DESIGN: : A
prospective randomized, controlled, single center study. SETTING: Medical
intensive care unit of an academic, tertiary care medical center. PATIENTS: Four
hundred forty-two consecutive patients admitted over a 4-month period who met
modified systemic inflammatory response syndrome criteria in a medical intensive
care unit. INTERVENTION: Patients were randomized to monitoring by an electronic
"Listening Application" to detect modified (systemic inflammatory response
syndrome) criteria vs. usual care. The listening application notified physicians
in real time when modified systemic inflammatory response syndrome criteria were
detected, but did not provide management recommendations. MEASUREMENTS AND MAIN
RESULTS: The median time to new antibiotics was similar between the intervention
and usual care groups when comparing among all patients (6.0 hr vs. 6.1 hr, p =
.95), patients with sepsis (5.3 hr vs. 5.1 hr; p = .90), patients on antibiotics
at enrollment (5.2 hr vs. 7.0 hr, p = .27), or patients not on antibiotics at
enrollment (5.2 hr vs. 5.1 hr, p = .85). The amount of fluid administered
following detection of modified systemic inflammatory response syndrome criteria
was similar between groups whether comparing all patients or only patients who
were hypotensive at enrollment. Other clinical outcomes including intensive care
unit length of stay, hospital length of stay, and mortality were not shown to be
different between patients in the intervention and control groups. CONCLUSIONS:
Realtime alerts of modified systemic inflammatory response syndrome criteria to
physicians in one tertiary care medical intensive care unit were feasible and
safe but did not influence measured therapeutic interventions for sepsis or
significantly alter clinical outcomes.
|*Early Diagnosis
[MESH]
|*Hospital Information Systems
[MESH]
|Anti-Bacterial Agents/therapeutic use
[MESH]
|Female
[MESH]
|Fluid Therapy/statistics & numerical data
[MESH]
|Hospital Mortality
[MESH]
|Humans
[MESH]
|Intensive Care Units
[MESH]
|Length of Stay/statistics & numerical data
[MESH]