Management of septic shock in intermediate care unit

Abstract

Background: While guidelines advocate goal-directed resuscitation based on timed bundles, the management of septic shock (SS) outside an ICU setting has been poorly studied in intermediate care units (IMCU).

Patients and method: We reviewed all cases of septic shock patients admitted to our IMCU between January 2013 and June 2014. The characteristics of sepsis, compliance of bundles, and outcomes were collected. The IMCU population was compared with the SS patients admitted to the ICU during the same period. The primary objective was to evaluate the feasibility of care in an IMCU.

Results: We treated 59 patients in the IMCU. Forty-three patients (73%) were fully managed in the IMCU and 16 patients (27%) were secondarily transferred to the ICU. In the first 3hours, the compliance to bundles was: blood cultures (95%), plasma lactate concentration (90%), vascular filling volume (1500ml (1000-2000)) and antibiotics (100%). A central venous line and an arterial catheter were inserted in 85% and 98.3% of the cases. At 24h, patients who were transferred to the ICU had higher lactate concentrations than the other patients (1.4±0.7mmol versus 2.9±3.4mmol; P=0.03). A 24 hours-SOFA score>4 was correlated with a transfer in ICU (OR 7,75 (95% CI 2.08-28,81; P=0.002)).

Conclusions: Our work demonstrated the ability to manage SS patients solely in an IMCU. It showed that the SS resuscitation bundle can be successfully implemented outside the ICU. A lack of improvement at the 24th hour is associated with a transfer to the ICU.

Keywords: Intermediate care unit; Management; Sepsis; Septic shock.