| Summary: | 碩士 === 國立陽明大學 === 生物醫學資訊研究所 === 101 === Patients with severe sepsis or septic shock for the intensive care unit medical staff is a major challenge for treatment. Many studies have shown that if sepsis symptoms appear early strict compliance with clinical guidelines for severe sepsis and septic shock: Early-Goal-Directed-Therapy (EGDT) can greatly reduce this type of patients’mortality. According to a study, if we can achieve the treatment goals in six hours, the 28 days mortality of patients with septic shock can be reduced by 49.2% to 33.3%. This reduction in mortality has great statistical significance.
However, in clinical-sensitive conditions, to fully comply with the early goal-oriented clinical guidelines is difficult. The one hand, clinicians are not familiar with the guidelines. On the other hand, clinicians in the face of the patients’all the parameters can not immediately respond to the impact of the patient's condition. Although most clinicians are aware of goal-directed therapy for sepsis patients, in fact, those who are able to meet the requirements are not expected high.
Most intensive care units of medical center in Taiwan face such a situation. Most of them are designed written form when carrying out early goal directed therapy, and the contents of the written form must be completed. But these written form design are very detailed; too detailed to fill. Repeating the rewriting process causes manual writing errors. As an afterthought making up the form, opportunities to treat the patients have been missed.
According to the characteristic of the clinical information systems in a intensive care unit of a medical center located in the north of Taiwan, we designed a digitized and real-time checklist. This checklist could record not only patient’s vital sign which includes cardiac rhythm, blood pressure, and central venous pressure but also return laboratory data such as lactate value, and central venous oxygen saturation automatically. This system could also provide clinical advisory to the clinicians according to the present condition. We further used this system to audit after treatment. Lactate clearance greater than 10% was chosen as our end point of EGDT for sepsis management. We then analyze the completion rate of EGDT to further evaluate this form whether there is a substantial help for clinical. The result showed that not only in the loss rate of data collection but also the goal achievements were all improved with statistics significance.
Keyword： Sepsis、Early-Goal-Directed-Therapy、 Clinical Information System、 Clinical Advisory system
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