Chest
Original ResearchCritical Care MedicineFactors Associated With Nonadherence to Early Goal-Directed Therapy in the ED
Section snippets
Materials and Methods
The Institutional Review Board of the University of Pennsylvania approved the study with an informed consent waiver. This was a retrospective cohort study of EGDT-eligible patients admitted through the University of Pennsylvania ED between 2005 and 2007. In late 2004, our ED institutionalized a Severe Sepsis protocol to identify and treat all EGDT-eligible patients. EGDT eligibility was defined as a serum lactate ≥ 4 mmol/L in hemodynamically stable patients (occult shock) or systolic BP < 90
Baseline Characteristics
The EGDT-eligible cohort included 340 adults (Fig 1). The age range of the cohort was 18 to 101 years and 54% were men. Septic shock was the criterion for EGDT in 183 patients (54%); 157 (46%) fulfilled occult shock criteria.
EGDT was not initiated in 142 patients (42%). The EGDT group (n = 198) received more IV fluids (P < .001), vasoactive agents (P < .001), and central venous catheterizations (P < .001) (Table 2). The inhospital mortality rate was 33% in the EGDT-initiated group and 30% in
Discussion
In this single-center cohort study, we found that EGDT was not initiated in 42% of eligible patients and was incomplete in 43% of patients in whom EGDT was initiated. We identified potential barriers to the initiation of EGDT at the patient, clinician, and organizational level. At the patient level, sex and severity of illness appeared to influence the decision to initiate EGDT. We found that the rate of EGDT use varied widely at the physician level and the sex of the physician appeared to
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Funding/Support: This study was supported in part by the National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, MD [Training Grant T32 HL07891].
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