Management of Severe Sepsis in the ICU – Including Mechanical Ventilation and Blood Sugar

• Main Authors: Ming-Cheng Chan, 詹明澄
• Other Authors: Yu Ru Kou
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/55617152775421032957

博士 === 國立陽明大學 === 生理學研究所 === 104 === Sepsis is a syndrome manifested by host reaction to infection. Sepsis is an important issue of public health as it is associated with substantial numbers of morbidity and mortality worldwide. Moreover, sepsis is one of the major reasons that patient admitted to intensive care unit (ICU) because septic patients often have life-threatening organ dysfunction. Acute respiratory failure is common in severe sepsis. Patients with severe sepsis often have increased risk of developing ARDS (acute respiratory distress syndrome), as sepsis is also the leading cause of ARDS. In the first part of our study, we retrospectively analyzed prospectively acquired data of septic patients with acute respiratory failure in Respiratory Intensive Care Unit (RICU) in Taichung Veterans General Hospital (TCVGH) from April 2008 to November 2009. Totally, 220 patients were included for analysis. We found that higher plateau pressure (Pplat) was associated higher mortality regardless of the presence of acute respiratory distress syndrome (ARDS). In multivariate regression analysis, Pplat at 24-hour after admission (Pplat-24) greater than 25 cm H2O was an independent risk factor for mortality (adjusted OR 2.33, 95% CI: 1.11-4.87; p=0.025 for hospital mortality). Transient hyperglycemia is common in hospitalized patients, especially those admitted to the intensive care unit (ICU). In the second part, we retrospectively analyzed prospectively acquired clinical data about glycemic control of patients with severe sepsis admitted to TCVGH RICU from July 2010 to June 2011. Totally, 127 patients (100 male and 27 female) were included for analysis. A 72-min-BGV (minimum blood glucose value within 72 hours of ICU admission) ≤ 120mg/dl was associated with increased 14-day mortality for all patients. Further subgroup analysis revealed that this association existed in non-diabetic patient only. In a multi-variate logistic regression analysis, non-diabetic patients with a 72-min-BGV ≤ 120mg /dl was an independent risk factor for 14-day mortality (adjusted OR 5.09, 95% C.I. 1.26–23.33, p=0.024). Mutildisciplinary approach is the cornerstone to successful management of sepsis. Both mechanical ventilation management and glycemic control are common and important issues while treating ICU patients with severe sepsis. These results may have inherent limitations from study design. We hope the results of these analyses can provide new information and help clinicians one step further to improve outcomes of patients with severe sepsis.