Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol*

Shapiro, Nathan I.; Howell, Michael D.; Talmor, Daniel; Lahey, D M; Ngo, Long; Buras, Jon A.; Wolfe, Richard E.; Weiss, J. Woodrow; Lisbon, Alan

doi:10.1097/01.ccm.0000206104.18647.a8

Cited by 311 publications

(193 citation statements)

References 27 publications

(36 reference statements)

Supporting

Mentioning

173

Contrasting

Unclassified

Order By: Relevance

“…6 Finally, due to our retrospective study design, we were unable to record details of fluid resuscitation such as whether the fluid was delivered with rapid and repeated fluid challenges, and whether the fluids were administered with resuscitation algorithms and according to physiological goals. 6,[21][22][23][24][25] The inability to control for potential imbalances in these factors limits our ability to identify possible associations between hospital mortality and increased quantity of fluid.…”

Section: Discussionmentioning

confidence: 99%

Resuscitating patients with early severe sepsis: A Canadian multicentre observational study

McIntyre

Fergusson

Cook

et al. 2007

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Background: Fluid resuscitation is a key factor in restoring hemodynamic stability and tissue perfusion in patients with severe sepsis. We sought to examine associations of the quantity and type of fluid administered in the first six hours after identification of severe sepsis and hospital mortality, intensive care unit (ICU) mortality, and organ failure. Methods:A retrospective, multicentre cohort study was undertaken at five Canadian tertiary care ICUs. We identified patients with severe sepsis admitted to the ICU between July 1, 2000, and June 30, 2002, using both administrative and clinical databases. Patients were included if they were hypotensive, had an infectious source, and at least two systemic inflammatory response syndrome criteria. We recorded total quantity and type of fluid administered for the first six hours after severe sepsis was identified. The first episode of hypotension defined the starting point for collection of fluid data. Multivariable regression analyses were performed to examine associations between quantity and type of fluid administered and hospital/ICU mortality, and organ failure.Results: Of 2,026 potentially eligible patient charts identified, 496 patients met eligibility criteria. The mean age and Acute Physiology and Chronic Health Evaluation score (APACHE II) were 61.8 ± 16.5 yr and 29.0 ± 8.0, respectively. No associations between quantity or type of fluid administered and hospital mortality or ICU mortality were identified, and there were no statistically significant associations between quantity or type of fluid administered and organ failure. However, more fluid resuscitation was associated with an increased risk of cardiovascular failure [odds ratio (OR) and 95% confidence interval Conclusion:An association between hospital mortality and quantity or type of fluid administered in the first six hours after the diagnosis of severe sepsis was not identifiable. These findings should be considered as hypothesis-generating and warrant confirmation or refutation by randomized controlled trials.

show abstract

Section: Discussionmentioning

confidence: 99%

Resuscitating patients with early severe sepsis: A Canadian multicentre observational study

McIntyre

Fergusson

Cook

et al. 2007

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…In fact, the majority of the studies in the early subgroup of this meta-analysis did not start quantitative resuscitation until intensive care unit admission leaving the possibility of some delay in treatment initiation among these studies. Although implementation requires that organizational and resource barriers be overcome, a number of reports have documented successful implementation of such programs (43)(44)(45)(46). Additionally, we observed distinct variations in the goals or end points targeted among the studies included in this analysis (Table 2).…”

Section: Discussionmentioning

confidence: 66%

207: The Effect of a Quantitative Resuscitation Strategy on Mortality in Patients With Sepsis: A Meta-Analysis

Jones

Brown

Trzeciak

et al. 2008

Annals of Emergency Medicine

View full text Add to dashboard Cite

Objective-Quantitative resuscitation consists of structured cardiovascular intervention targeting predefined hemodynamic end points. We sought to measure the treatment effect of quantitative resuscitation on mortality from sepsis.Data Sources-We conducted a systematic review of the Cochrane Library, MEDLINE, EMBASE, CINAHL, conference proceedings, clinical practice guidelines, and other sources using a comprehensive strategy.Study Selection-We identified randomized control trials comparing quantitative resuscitation with standard resuscitation in adult patients who were diagnosed with sepsis using standard criteria. The primary outcome variable was mortality.Data Abstraction-Three authors independently extracted data and assessed study quality using standardized instruments; consensus was reached by conference. Preplanned subgroup analysis required studies to be categorized based on early (at the time of diagnosis) vs. late resuscitation implementation. We used the chi-square test and I 2 to assess for statistical heterogeneity (p < 0.10, I 2 > 25%). The primary analysis was based on the random effects model to produce pooled odds ratios with 95% confidence intervals.Results-The search yielded 29 potential publications; nine studies were included in the final analysis, providing a sample of 1001 patients. The combined results demonstrate a decrease in mortality (odds ratio 0.64, 95% confidence interval 0.43-0.96); however, there was statistically significant heterogeneity (p = 0.07, I 2 = 45%). Among the early quantitative resuscitation studies (n = 6) there was minimal heterogeneity (p = 0.40, I 2 = 2.4%) and a significant decrease in mortality (odds ratio 0.50, 95% confidence interval 0.37-0.69). The late quantitative resuscitation studies (n = 3) demonstrated no significant effect on mortality (odds ratio 1.16, 95% confidence interval 0.60-2.22). Despite its endorsement by 11 professional societies, the recommendation has produced significant controversy, in part because it relied heavily on one study (6-10). Conclusion-ThisScientific knowledge is cumulative; therefore new research findings should be interpreted based on what is already known (11). Recognizing that clinical trials of quantitative resuscitation were published for nearly two decades before the Rivers et al. study, we hypothesized that their results could be aggregated to produce more definitive conclusions about the treatment effect of quantitative resuscitation in sepsis. Therefore, we conducted a meta-analysis to examine the available evidence investigating a quantitative resuscitation strategy for patients with sepsis, to determine the treatment effect of such a strategy on mortality, and to determine whether the timing of implementation of quantitative resuscitation impacts mortality. METHODS Search Strategy for Identification of StudiesA written protocol following recommended guidelines that was finalized before beginning the study was followed (12). We searched the Cochrane Library, MEDLINE (1965( -August 2007, EMBASE (1974( -Augu...

show abstract

“…A partir de entonces, se han corroborado los beneficios de esta estrategia de reanimación en múltiples estudios (9,10,(14)(15)(16)(17). A pesar de los hallazgos y de ser una estrategia recomendada en las guías internacionales y por importantes sociedades e instituciones, es preocupante ver la poca observancia a las guías detectada en diferentes sitios del mundo.…”

Section: Discussionunclassified

Adherencia a las guías internacionales de manejo temprano en sepsis grave y choque séptico

et al. 2012

View full text Add to dashboard Cite

e Isadora Ortiz: participaron en el diseño del estudio, la recolección de datos, el análisis de la información y la escritura del manuscrito. Fabian Jaimes participó en el diseño del estudio, el análisis de la información y la revisión del manuscrito. Introducción. La observancia completa del tratamiento temprano dirigido por objetivos, disminuye significativamente la mortalidad a 28 días, mientras que la observancia parcial no tiene ningún beneficio. Objetivos. Determinar la observancia de las guías internacionales en sepsis grave y choque séptico, mediante el conjunto de medidas (bundle) de reanimación de las primeras seis horas en pacientes mayores de 16 años de edad, en un centro de referencia de alta complejidad. Materiales y métodos. Se presenta un estudio de cohorte, prospectivo y descriptivo, llevado a cabo durante un período de seis meses, en pacientes con sepsis grave o choque séptico admitidos a los servicios de urgencias, unidades de cuidados intensivos y cuidados especiales. Se midió la observancia del conjunto de medidas mediante ocho intervenciones: 1) medición del lactato sérico, 2) inicio temprano de antibióticos, 3) toma de hemocultivos, 4) infusión de líquidos intravenosos, 5) uso de medicamentos vasopresores, 6) inserción de catéter venoso central, 7) presión venosa central mayor de 8 mm Hg, y 8) saturación venosa central de oxígeno mayor de 70 %.Resultados. Se tamizaron 723 pacientes; 16 % (n=116) cumplieron los criterios de inclusión, 92,2 % (n=107) cumplieron los criterios para sepsis grave y 37,9 % (n=44) para choque séptico. El 62,9 % (n=73) fue subdiagnosticado. La observancia completa de las 8 intervenciones del conjunto de medidas fue de 0 %; de 6 a 7, 19 % (n=22); de 3 a 5, 67,2 % (n=78), y de 0 a 2, 98,3 % (n=114). Conclusión. La completa observancia de las guías internacionales de manejo en sepsis grave y choque séptico en las primeras seis horas es nula y solo se cumple de manera parcial. Adherence to international guidelines on early management in severe sepsis and septic shock Introduction. Complete adherence to early goal-directed therapy has shown a significant reduction in 28-day mortality rate, whereas partial adherence has not shown beneficial effect. Objectives. The effect of adherence to 6 hour sepsis bundle treatment was evaluated on patients with severe sepsis and septic shock. Materials and methods. A prospective cohort study was conducted during a six-month period. The patients were limited to those 16 years or older and included admissions to intensive care units, special care units or emergency departments with severe sepsis or septic shock. The adherence to the 6-hour sepsis bundle was evaluated through 8 interventions as follows: (1) serum lactate measure,( 2) early antibiotic administration, (3) blood culture samples, (4) infusion of intravenous fluids, (5) vasopressor use, (6) central venous catheter, (7) central venous pressure >8 mm Hg, and (8) central venous oxygen saturation >70%. Results. Seven hundred and twenty three patients were screened; 16% (n=116) me...

show abstract

Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol*

Cited by 311 publications

References 27 publications

Resuscitating patients with early severe sepsis: A Canadian multicentre observational study

Resuscitating patients with early severe sepsis: A Canadian multicentre observational study

207: The Effect of a Quantitative Resuscitation Strategy on Mortality in Patients With Sepsis: A Meta-Analysis

Adherencia a las guías internacionales de manejo temprano en sepsis grave y choque séptico

Contact Info

Product

Resources

About