Document Detail


Using transcutaneous oxygen pressure measurements as selection criteria for activated protein C use.
MedLine Citation:
PMID:  18580526     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Limited resources and the expense of Activated Protein C (APC) (drotrecogin alfa) may contribute to the reluctance to utilize this drug in sepsis. Employing the PROWESS criteria resulted in absolute reduction in 28-day mortality of 6.1%, representing a relative risk reduction of 19.4%. Additional patient categorization and selection may lead to less frequent drug use with the same survival advantage. We used transcutaneous partial pressure of oxygen (PtcO2) as an indicator of microcirculatory perfusion to identify which septic patients may benefit from APC. METHODS: Nineteen patients consecutively admitted with severe sepsis or septic shock that fulfilled the PROWESS criteria for APC treatment. APC was administered to patients with the PROWESS selection criteria, only if the PtcO2 information demonstrated tissue ischemia. RESULTS: Nineteen patients met the PROWESS criteria. Ten patients demonstrated poor tissue perfusion using PtcO2 monitors and received APC. Nine patients had adequate tissue perfusion and did not receive APC. There were no differences in age, gender, APACHE II scores, lactate levels, or organ failure between the two groups. The 10 patients who received APC had a mortality of 3 of 10 (30%). The survivors of this group uniformly converted to PtcO2 values consistent with survival within 12 hours to 24 hours of drug administration. The nine patients who did not receive APC had a mortality of 2 of 9 (22%), not statistically significant from those who received the drug (p = 0.89). CONCLUSION: Withholding APC did not result in an increase in mortality from severe sepsis in those patients who demonstrated adequate PtcO2 values. The transcutaneous oxygen measurement may be a useful adjuvant in addition to the other selection criteria for better identification of patients who may benefit from APC.
Authors:
Alyssa D Chapital; Mihae Yu; Hao Chih Ho; John Wang; Wega Koss; Danny M Takanishi
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  65     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-11     Completed Date:  2008-07-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  30-3     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anti-Infective Agents / therapeutic use*
Blood Gas Monitoring, Transcutaneous*
Female
Health Status Indicators
Humans
Male
Microcirculation / physiopathology
Middle Aged
Patient Selection*
Protein C / therapeutic use*
Recombinant Proteins / therapeutic use
Reproducibility of Results
Sepsis / blood*,  drug therapy*,  mortality
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Infective Agents; 0/Protein C; 0/Recombinant Proteins; 0/drotrecogin alfa activated

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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