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The impact of intensive care unit admissions following early resuscitation on the outcome of patients with severe sepsis and septic shock.

BACKGROUND
Septic shock is a serious condition associated with a high mortality rate. The 'Early goal-directed therapy" has been reported as the effective treatment. Whether or not an intensive care unit (ICU) admission can improve the outcomes of septic shock patients, has not been elucidated.


OBJECTIVE
To evaluate the impact of direct ICU admission after initial resuscitation in the emergency room (ER) on the outcomes of patients in septic shock.


MATERIAL AND METHOD
A prospective cohort study including severe sepsis and septic shock patients who were admitted from the ER during the period from April 2011 to September 2012. The recorded information includes patients' baseline characteristics, hemodynamic parameters, and outcomes. The comparisons were performed between the ICU versus the non-ICU admission groups. The principal outcome was 28-day mortality.


RESULTS
Of the 175 enrolled patients, 50 patients were directly admitted to the ICU and 125 patients were admitted to a general medical ward. The ICU patients were younger (58.6 +/- 19.7 vs. 66.0 ++/- 5.1 year-old, p = 0.02), had lower mean arterial blood pressures (57.8 +/- 15.3 vs. 66.6 ++/- 8.4 mmHg, p < 0.001) and presented with a higher proportion of metabolic acidosis (60% vs. 33.6%, p = 0.002). In comparison to the non-ICU group, the ICU patients received larger volume resuscitation for the first 24 hours (5,694.4 +/- 2,018.5 vs. 5,004.7 +/- 1,729.7 ml, p = 0.04); had received norepinephrine (88% vs. 68%, p = 0.007) and/or dobutamine (20% vs. 4.8%, p = 0.003), and were treated for renal replacement therapy (28% vs. 5.6%, p < 0.001) in higher proportions. There were trends toward a lower 28 day mortality (18% vs. 25.6%, p = 0.33) among the patients in the ICU group.


CONCLUSIONS
Apart from the early goal-directed therapy, early ICU admission substantially improves the outcomes of septic shock patients.