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Volume 3 Supplement 1

ESICM LIVES 2015

Trends in vital signs and routine biomarkers in sepsis patients during resuscitation in the emergency department: a prospective observational pilot study

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Introduction

Sepsis lacks a reliable measure of disease activity [1, 2]. Therefore, it remains unclear how to monitor the response to treatment. Little is known about changes in vital signs during sepsis resuscitation and biomarkers for disease activity are not available to evaluate effects of treatment in sepsis patients at the bedside [2, 3]. Trends in vital signs and biomarker levels during resuscitation might provide information about response to treatment at a very early stage of sepsis.

Objectives

Detect trends in vital signs and routine biomarker levels during sepsis resuscitation in the emergency department (ED).

Methods

Prospective observational pilot study in the ED of a tertiary care teaching hospital. Adult non-trauma patients with two or more SIRS criteria and suspected infection were included. Blood samples were taken and vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation and temperature) measured at admittance to the ED (T0) and 3 hours later (T1) and the differences between T0 and T3 (delta) were analyzed.

Results

In total data of 99 patients was analyzed. Of these patients, 63 presented with sepsis, 30 with severe sepsis and 6 patients had septic shock. Trends in vital signs and routine biomarker levels are respectively shown in Figure 1 and Figure 2. All vital signs decreased, except for peripheral oxygen saturation which increased. The heart rate and respiratory rate dropped by over 10% during resuscitation (p < 0.001). At the same time, the systolic and diastolic blood pressure decreased respectively with 5% and more than 9% (p < 0.001). Almost all biomarker levels decreased during resuscitation, except for CRP, bands, potassium, Troponin T and direct bilirubin that remained stable. Sodium, chloride and NT pro-BNP increased slightly.

Figure 1
figure1

Delta in vital signs between T 0 and T 1 .

Figure 2
figure2

Delta in biomarker levels between T 0 and T 1 .

Conclusions

Vital signs and biomarker levels showed descending trends during resuscitation, except for parameters directly affected by treatment modalities. Despite these trends patients clinically improved. Trends in vital signs and routine biomarkers might be helpful in predicting clinical course and response to treatment in sepsis patients.

References

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    Marshall JC, Vincent J, Guyatt G, Angus DC, Abraham E, Bernard G, Bombardier C, Calandra T, Jørgensen HS, Sylvester R: Outcome measures for clinical research in sepsis: a report of the 2nd Cambridge Colloquium of the International Sepsis Forum. Crit Care Med. 2005, 33: 1708-1716. 10.1097/01.CCM.0000174478.70338.03.

  2. 2.

    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013, 39: 165-228. 10.1007/s00134-012-2769-8.

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    Samraj RS, Zingarelli B, Wong HR: Role of biomarkers in sepsis care. Shock. 2013, 40: 358-365. 10.1097/SHK.0b013e3182a66bd6.

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Author information

Correspondence to VM Quinten.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Keywords

  • Emergency Department
  • Respiratory Rate
  • Septic Shock
  • Severe Sepsis
  • Vital Sign