Effect Of Early Goal-directed Therapy On The Morbility, Severity And Mortality Of Multiple Organ Dysfunction Syndrome

BackgroundMultiple organ dysfunction syndrome remains the most important factor associated with mortality in the SICU. Most cases of MODS are precipitated by infection. There are an estimated 751,000 cases (3.0 cases per 1000 population) of sepsis or septic shock in the United States each year, and 225,000 patients with septic shock dead.A multiple-center and prospective survey of the patients with MODS admitted to 37 hospitals in 11 provinces from March 2002 to January 2005. The total mortality of the 1087 patients was 60.4%. Although many cases of MODS are precipitated by infection, patients with MODS who die often have no demonstrable active infection on postmortem examination.An article from Rivers et al raised huge international enthusiasm.demonstrated an impressive decrease in mortality of patients with septic shock,which went from 48.3% to 30.0%. Objectives1.To investigate the effect of early goal-directed therapy on the morbility, severity and mortality of patients ,who with multiple organ dysfunction syndrome in ICU.2.As the same time, To investigate whether EGDT can be used in patients without severe sepsis/septic shock.MethodsEGDT Monitoring of central venous oxygen saturation was discontinued(1/h).During the first 6 hrs of resuscitation of severe sepsis or septic shock, if central venous oxygen saturation or mixed venous oxygen saturation of 70% is not achieved with fluid resuscitation to a central venous pressure of 8-12 mm Hg, then transfuse packed red blood cells to achieve a hematocrit of 30% and/or administer a dobutamine infusion (up to a maximum of 20μg per kilogram per minute) to achieve this goal. Dobutamine was decreased in dose or discontinued if the mean arterial pressure was less than 65 mm Hg or if the heart rate was above 120 beats per minute. After this,the pressure was stillless than 65 mm Hg, pressor agent should be gived, norepinephrine, NE is the primal selection.CONTROLLED The goal of central venous pressure of 8-12 mm Hg, mean arterial pressure was less than 65 mm Hg and Urine output 0.5mL/kg/hr achieved only. Without monitoring of central venous oxygen saturation. If central venous pressure of 8-12 mm Hg, mean arterial pressure was less than 65mmHg and Urine output 0.5mL/kg/hr is not achieved with fluid resuscitation, administer a dobutamine infusion (up to a maximum of 20μg per kilogram per minute) to achieve this goal. Without monitoring of central venous oxygen saturation. The patients' temperature, heart rate, urine output, blood pressure,and central venous pressure were measured continuously forthe first 6 hours of treatment and assessed every 24 hours for 72hours. lactate concentrations, and coagulation-related variables and clinical variables required for determination of the Acute Physiology and Chronic Health Evaluation (APACHE II) score (on a scale from 0 to 71, with higher scores indicating more severe organ dysfunction), The scores of APACHE II , The results of laboratory tests required only for purposes of the study were made known only to the study investigators. Lactate concentration in blood (Lactate₀) and SOFA scores (SOFA₀) of the two groups were recorded when the patients were admissioned , also the Lactate concentration of the second and fourth day (Lactate₂, Lactate₄) , the highest SOFA scores (SOFA_T ) during the admission . The depreciation of the two SOFA scores (SOFA_Δ) , the counts of organ dysfunction and the mortality of the two groups in ICU were calculated at the end of the study.Statistical analysis was done with the software program SPSS 13.0, quantitativeresults presented are the mean±standard deviation (SD) ((X|-)±s), comparison meanswas used with Independent-Samples T Test and the Clustered Error Bar, comparison numeration data was done with Chi-Square Test, a probability value (p value ) of less than 0.05 was considered significant.ResultsThe morbility of MODS in EGDT group was significantly lower than that in controlled group (P=0.021) .The Lactate₂ , Lactate₄ , SOFA_T, SOFA_Δ, and the counts of organ dysfunction of MODS in EGDT group were significantly lower than those in controlled group (P=0.005, 0.006, 0.017, 0.008, 0.002) . In-hospital mortality was 27.2 percents in the group assigned to early goal-directed therapy, as compared with 48 percents in the group assigned to standard therapy (P=0.003).The mortality of the MODS patients with severe sepsis in EGDT group was significantly lower than that in controlled group (P=0.030) , also the mortality of the MODS patients without severe sepsis in EGDT group was significantly lower than that in controlled group (P=0.048) .ConclusionsThe results of our study demonstrate that EGDT can decrease the morbility , severity and mortality of MODS. And EGDT can also decrease the mortality of MODS with or without severe sepsis.