Severe Sepsis Mortality in a Community Teaching. Hospital: 1983–1985 and 1989–1990

Abstract

Despite better understanding of the pathophysiology and hemodynamic abnormalities of severe sepsis, mortality remains high. We examined the severity-adjusted outcome and use of pulmonary artery catheterization (PAC) in patients with severe sepsis during 1983 to 1985 and 1989 to 1990 in an intensive care unit (ICU) staffed by full-time intensivists. A retrospective chart review was conducted on severe sepsis patients admitted to a multidisciplinary ICU of an 850-bed community teaching hospital. Patients were identified at ICU admission and at 24 and 48 hours after ICU admission. Patients were stratified by severity of illness using the Mortality Probability Model (MPM) and presence or absence of a pulmonary artery catheter within the first 48 hours of ICU admission. In the years 1983 through 1985 and 1989 through 1990, respectively, 245 and 132 patients with severe sepsis were identified. The severity-adjusted outcome and use of PAC was analyzed both within and between these two periods. The severity adjusted mortality from sepsis was unchanged over time (63% in 1983–1985 and 51% in 1989–1990; p = 0.491). Pulmonary artery catheter use increased from 52.2% in 1983 to 1985 to 64.4% in 1989 to 1990 ( p = 0.023). Invasive monitoring with PAC was used in a less severely ill population; during 1983 to 1985, mean severity estimated by MPM was 0.43 compared with an MPM of 0.32 in 1989 to 1990 ( p = 0.003). A significant increase in the therapeutic use of vasoactive drugs (65 vs 81%) to treat severe sepsis was observed over the two periods ( p = 0.0005). Outcome of severe sepsis was unchanged during the two periods. Applying an ICU severity-of-illness adjustment model, early employment of pulmonary artery catheters and increased use of vasopressors did not effect outcome in an intensivist-managed ICU. Insertion of pulmonary artery catheters in patients with less severe illness also did not impact outcome. Use of pulmonary artery catheters to monitor and guide treatment needs further rigorous prospective evaluation to define the specific conditions in severely septic patients for which this intervention is most applicable.