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Randomized Controlled Trial
. 2011 Oct;82(10):1289-93.
doi: 10.1016/j.resuscitation.2011.06.015. Epub 2011 Jun 23.

Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock

Michael A Puskarich  1 , Stephen Trzeciak, Nathan I Shapiro, Alan C Heffner, Jeffrey A Kline, Alan E Jones; Emergency Medicine Shock Research Network (EMSHOCKNET)
Affiliations
Randomized Controlled Trial

Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock

Michael A Puskarich et al. Resuscitation. 2011 Oct.

Abstract

Introduction: We sought to compare the outcomes of patients with cryptic versus overt shock treated with an emergency department (ED) based early sepsis resuscitation protocol.

Methods: Pre-planned secondary analysis of a large, multicenter ED-based randomized controlled trial of early sepsis resuscitation. All subjects were treated with a quantitative resuscitation protocol in the ED targeting 3 physiological variables: central venous pressure, mean arterial pressure and either central venous oxygen saturation or lactate clearance. The study protocol was continued until all endpoints were achieved or a maximum of 6h. Outcomes data of patients who were enrolled with a lactate ≥ 4mmol/L and normotension (cryptic shock) were compared to those enrolled with sustained hypotension after fluid challenge (overt shock). The primary outcome was in-hospital mortality.

Results: A total of 300 subjects were enrolled, 53 in the cryptic shock group and 247 in the overt shock group. The demographics and baseline characteristics were similar between the groups. The primary endpoint of in-hospital mortality was observed in 11/53 (20%, 95% CI 11-34) in the cryptic shock group and 48/247 (19%, 95% CI 15-25) in the overt shock group, difference of 1% (95% CI -10 to 14; log rank test p=0.81).

Conclusion: Severe sepsis with cryptic shock carries a mortality rate not significantly different from that of overt septic shock. These data suggest the need for early aggressive screening for and treatment of patients with an elevated serum lactate in the absence of hypotension.

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Conflict of interest statement

Conflict of Interest Statement

None of the authors have any conflicts of interests to report.

Figures

Figure 1
Figure 1
Study flow diagram
Figure 2
Figure 2
Kaplan-Meier survival curves for overt shock and cryptic shock groups
See this image and copyright information in PMC

Comment in

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