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Abstract：
Source control is important in management of septic shock. We studied differences in outcomes of patients with sepsis and septic shock who required source control intervention compared with those who did not need such intervention and the effect of the timing of source control on various clinical outcomes.
METHODS: Prospective observational study from February 28, 2020, to March 31, 2021.
METHODS: Medical ICU of academic quaternary medical center.
METHODS: Two hundred five adult (≥18 yr) ICU patients.
METHODS: None.
RESULTS: Patients were divided into a medical treatment group and a source control group. Patients requiring source control were further divided into early (intervention performed < 24 hr) and late (≥ 24 hr) source control groups. The primary outcomes were 30-day and ICU mortality. Secondary outcomes were ICU and hospital length of stay (LOS), days on mechanical ventilation, and need for renal replacement therapy. A total of 45.9% patients underwent source control. Of these, early source control was performed in 44.7% and late source control in 55.3% of patients. There was no significant difference in 30-day mortality or ICU mortality in the medical versus source control groups or in early versus late source control groups. Compared with the medical group, mean hospital LOS (11.5 vs 17.4 d; p < 0.01) and ICU LOS (5.2 vs 7.7 d; p < 0.01) were longer in the source control group. The hospital LOS (12.5 vs 21.4 d; p < 0.01) and ICU LOS (5.2 vs 9.7 d; p < 0.01) were also longer in patients who had delayed source control than in patients who had early source control. There were no significant differences in other outcomes.
CONCLUSIONS: Although mortality was similar, patients who had delayed source control had a longer ICU and hospital LOS. Early source control may improve health care utilization in septic shock patients.
METHODS: Prospective observational study from February 28, 2020, to March 31, 2021.
METHODS: Medical ICU of academic quaternary medical center.
METHODS: Two hundred five adult (≥18 yr) ICU patients.
METHODS: None.
RESULTS: Patients were divided into a medical treatment group and a source control group. Patients requiring source control were further divided into early (intervention performed < 24 hr) and late (≥ 24 hr) source control groups. The primary outcomes were 30-day and ICU mortality. Secondary outcomes were ICU and hospital length of stay (LOS), days on mechanical ventilation, and need for renal replacement therapy. A total of 45.9% patients underwent source control. Of these, early source control was performed in 44.7% and late source control in 55.3% of patients. There was no significant difference in 30-day mortality or ICU mortality in the medical versus source control groups or in early versus late source control groups. Compared with the medical group, mean hospital LOS (11.5 vs 17.4 d; p < 0.01) and ICU LOS (5.2 vs 7.7 d; p < 0.01) were longer in the source control group. The hospital LOS (12.5 vs 21.4 d; p < 0.01) and ICU LOS (5.2 vs 9.7 d; p < 0.01) were also longer in patients who had delayed source control than in patients who had early source control. There were no significant differences in other outcomes.
CONCLUSIONS: Although mortality was similar, patients who had delayed source control had a longer ICU and hospital LOS. Early source control may improve health care utilization in septic shock patients.
摘要：
源头控制在感染性休克的管理中很重要。我们研究了需要源控制干预的脓毒症和脓毒性休克患者与不需要此类干预的患者的结局差异，以及源控制时机对各种临床结局的影响。
方法：2020年2月28日至2021年3月31日的前瞻性观察性研究。
方法：第四医学中心医学ICU。
方法：250名成人（≥18岁）ICU患者。
方法：无。
结果：患者分为药物治疗组和源对照组。需要源控制的患者进一步分为早期（干预<24小时）和晚期（≥24小时）源对照组。主要结果是30天和ICU死亡率。次要结果是ICU和住院时间（LOS），机械通气的天数，需要肾脏替代治疗.共有45.9％的患者进行了源控制。其中,44.7%的患者进行了早期源控制,55.3%的患者进行了晚期源控制.在医疗对照组与来源对照组或早期与晚期来源对照组中，30天死亡率或ICU死亡率没有显着差异。与医疗组相比，来源对照组的平均住院LOS（11.5vs17.4d；p<0.01）和ICULOS（5.2vs7.7d；p<0.01）更长。延迟源控制的患者的医院LOS（12.5vs21.4d；p<0.01）和ICULOS（5.2vs9.7d；p<0.01）也比早期源控制的患者更长。其他结果无显著差异。
结论：尽管死亡率相似，延迟源控制的患者ICU和医院LOS更长.早期源头控制可以提高感染性休克患者的医疗保健利用率。
方法：2020年2月28日至2021年3月31日的前瞻性观察性研究。
方法：第四医学中心医学ICU。
方法：250名成人（≥18岁）ICU患者。
方法：无。
结果：患者分为药物治疗组和源对照组。需要源控制的患者进一步分为早期（干预<24小时）和晚期（≥24小时）源对照组。主要结果是30天和ICU死亡率。次要结果是ICU和住院时间（LOS），机械通气的天数，需要肾脏替代治疗.共有45.9％的患者进行了源控制。其中,44.7%的患者进行了早期源控制,55.3%的患者进行了晚期源控制.在医疗对照组与来源对照组或早期与晚期来源对照组中，30天死亡率或ICU死亡率没有显着差异。与医疗组相比，来源对照组的平均住院LOS（11.5vs17.4d；p<0.01）和ICULOS（5.2vs7.7d；p<0.01）更长。延迟源控制的患者的医院LOS（12.5vs21.4d；p<0.01）和ICULOS（5.2vs9.7d；p<0.01）也比早期源控制的患者更长。其他结果无显著差异。
结论：尽管死亡率相似，延迟源控制的患者ICU和医院LOS更长.早期源头控制可以提高感染性休克患者的医疗保健利用率。
