Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension

Abstract

The effect of an early resuscitation protocol on sepsis outcomes in developing countries remains unknown.OBJECTIVE To determine whether an early resuscitation protocol with administration of intravenous fluids, vasopressors, and blood transfusion decreases mortality among Zambian adults with sepsis and hypotension compared with usual care. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 212 adults with sepsis (suspected infection plus Ն2 systemic inflammatory response syndrome criteria) and hypotension (systolic blood pressure Յ90 mm Hg or mean arterial pressure Յ65 mm Hg) presenting to the emergency department at a 1500-bed referral hospital in Zambia between

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“…In the study by Andrews et al [23] adult patients with septic shock were randomized to receive a 2 L fluid bolus as compared to standard of care. In the FEAST study children with severe sepsis were randomized to a bolus of Saline or Albumin (40 mL kg -1 ) or no bolus [14].…”

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“…A similar study in adults with septic shock was performed by Andrews et al [42]. Adults with sepsis (n=209) presenting to an emergency department in Zambia who were randomized to receive intravenous fluids, vasopressors, and blood transfusion had significantly higher mortality in hospital compared with usual care (48.1% vs 33.0%, respectively [42].…”

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“…The chest x-ray does not show any definite areas of consolidation. Although repeated fluid boluses were at one time the gold standard for sepsis care, more recent evidence suggests that this might be harmful (5)(6)(7)(8). The abdominal CT scan shows the Foley balloon in the penis and the bladder grossly distended.…”