Consensus Reached on How to Recognise and Manage Sepsis and Septic Shock by Intensivists in Northeast Nigeria Held at the University of Maiduguri Teaching Hospital, Borno State Nigeria

IntroductionSevere sepsis and septic shock, is a common cause of emergency room admission and is associated with high morbidity and mortality worldwide. This study inspects the prediction of mortality in severe sepsis and septic shock with increased lactate/albumin ratio.Objective The objective of the study was to predict the serum lactate albumin ratio as an indicator of mortality in severe sepsis and septic shock.MethodologyIt was a hospital based cross sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from November 2015 to October 2016. The consent was taken from patients. Acute Physiology and Chronic Health Evaluation II score, serum lactate and serum albumin levels on first day of arrival in emergency room were calculated. Patients were classified as severe sepsis and septic shock and treated according to Surviving Sepsis Campaign 2012 guideline. The patient were follow up at 28 day, The associations of 28-day outcome with Acute Physiology and Chronic Health Evaluation II score, serum lactate value, serum albumin value and serum lactate albumin ratio value were derived.ResultsOut of total 240 severe sepsis and septic shock patients it is found that increased serum lactate/albumin ratio was an independent predictor of the mortality with cut off value of 0.07. Furthermore serum lactate albumin ratio shows strong correlation with APACHE 2 score in predicting mortality in severe sepsis and septic shock.ConclusionIncreased lactate/albumin ratio predicts mortality in patients with severe sepsis and septic shock. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 191-195

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Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽

10.32895/ump.mpr.2.3.27 ◽

2018 ◽

Vol 2 (3) ◽

pp. 27-32

Author(s):

Bien Le ◽

Dai Huynh ◽

Mai Tuan ◽

Minh Phan ◽

Thao Pham ◽

...

Keyword(s):

Blood Pressure ◽

Septic Shock ◽

Severe Sepsis ◽

Fluid Responsiveness ◽

Statistical Significance ◽

Venous Pressure ◽

Fluid Bolus ◽

Low Blood Pressure ◽

Low Central Venous Pressure ◽

Sepsis And Septic Shock

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock. Design: observational study. Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%. Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers). Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

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