Echo vs. EGDT in Severe Sepsis and Septic Shock

Launched by INTERMOUNTAIN HEALTH CARE, INC. · Feb 2, 2015

Keywords

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Gender

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Eligibility criteria

• Inclusion Criteria:
• • At least 18 years of age
• • Suspected infection
• • Two or more systemic inflammatory response syndrome (SIRS) criteria
• • White blood cell count less than 4,000 per mm3, greater than 12,000 per mm3, or differential with greater than 10% immature forms
• • Heart rate greater than 90 beats per minute
• • Respiratory rate greater than 20 breaths per minute or paCO2 less than 32 mmHg
• • Temperature less than 36°C or greater than 38°C
• * Evidence of refractory hypoperfusion attributed to sepsis (one or more of the following):
• • Systolic blood pressure less than 90 mmHg despite an intravenous fluid challenge of at least 30ml/kg (a portion of this may be albumin equivalent)
• • Blood lactate level at least 4 mmol/L.
• • Intention to place an arterial catheter.
• • Intention to place a central venous catheter.
• Exclusion criteria:
• • Known pregnancy
• • Requirement for immediate surgery
• • Hypotension attributed to alternative cause
• • Treating physician deems the patient is moribund
• • Treating physician deems aggressive care is unsuitable
• • Contraindication to central venous catheterization or arterial catheterization
• • Advanced directives restricting implementation of the protocol
• • Significant pathology of the chest or abdominal wall that would make transthoracic echocardiography impossible (burns, chest trauma, etc.)
• • Children under the age of 18 will not be included in this study