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• W2334589871 abstract "Introduction: The role of bioreactance noninvasive cardiac output monitor (NICOM) in sepsis is unclear. We evaluated a NICOM guided early treatment of patients with severe sepsis/septic shock. Methods: Retrospective case control study during introduction of NICOM into standardized hospital sepsis resuscitation protocol at a 919 bed university affiliated hospital. All patients were identified by automated electronic sepsis surveillance and managed by sepsis team. NICOM group: 34 patients with MAP<65 (SBP <90) and lactate >2.5, or need for vasopressors (Dec 2012-May 2013). Hypotension was corrected with fluids and norepinephrine. Fluids were given until patients were preload unresponsive (stroke volume index change <=10% after fluid bolus or passive leg raising) or treatment endpoints were met. Dobutamine was used if stroke volume index<33 (EF <40%). Treatment endpoints were lactate clearance >10%/2 h (Scvo2 >70% if available). Echocardiography was used depending on availability. Control group: 34 matched patient from sepsis database (Aug 2012-May 2013), treated according to current sepsis guidelines. Primary outcomes: lactate clearance, normalization, and daily net fluid balance. We also compared PRBC and dobutamine use, ICU and hospital mortality and LOS, duration of shock and mechanical ventilation. Chi-square, t-test were used for analysis. Skewed length of stay (LOS) was normalized and t-test was used. Results: NICOM and controls were matched for age (69.7 vs. 69.2 y), gender (male 58.8 vs. 55.9%), APACHE 2 (median 20 [IQR 16-29] vs. 19.5 [16-27]), initial lactate (3.6 mmol/l [SD 2.4] vs. 2.9 [SD 2]), and baseline mechanical ventilation (57% vs. 43.3%) (all p>0.05). 6 hour lactate clearance (NICOM vs. controls): 22.5% vs. 5.7%; 6 hour lactate normalization: 54.5% vs. 43.4% (all p>0.05), and no difference at 12 and 24 hours. Net daily fluid balance: day 1=4.7 (SD 2.8) vs. 4.0 (3.3) L; d 2 = 2.2 (1.9) vs. 1.7 (2.0) L; d 3 = 0.6 (1.2) vs. 1.0 (1.9) L (all p>0.05). ICU mortality (23.5% vs. 29.4%, OR 0.9 [95% CI 0.5-1.4]), hospital mortality (32.4% vs. 44.1%, OR 0.8 [95% CI 0.5-1.4]), ICU LOS (log10 mean 0.71 [SD 0.4] vs. 0.6 [SD 0.4]), hospital LOS (log10 mean 1.0 [SD 0.4] vs. 1.0 [SD 0.4]), shock (mean 2.4 d [SD 3.6] vs. 1.4 d [SD 1.7]) and shock-free days (mean 5.7 d [SD 7.7] vs. 4.7 d [SD 4.7]), mechanical ventilation (65 vs. 50%), ventilator (mean 4.3 d [SD 6.7] vs. 3.5 d [SD 6.7]) and ventilator free days (mean 2.8 d [SD 2.5] vs. 2.4 d [SD 2.5]), PRBC (11.7% vs. 26.5%) and dobutamine use (20.6% vs 17.6%) were not different (all p>0.05). Conclusions: NICOM guided treatment in sepsis is feasible. Compared to controls, there was no difference in lactate clearance, lactate normalization, and daily net fluid balance. Adequately powered randomized trial is needed to evaluate effect on outcomes." @default.
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• W2334589871 date "2013-12-01" @default.
• W2334589871 modified "2023-10-18" @default.
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• W2334589871 doi "https://doi.org/10.1097/01.ccm.0000440353.61600.7c" @default.
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