Maurice A, Seguin P, Aguillon D, Chanavaz C, Mallédant Y. Traitement par la protéine C activée : expérience à propos de 23 patients dans un contexte périopératoire.
ACTA ACUST UNITED AC 2005;
24:343-6. [PMID:
15826783 DOI:
10.1016/j.annfar.2005.02.014]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 02/10/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE
To evaluate the use of activated C protein (ACP) in a Surgical Intensive Care Unit.
STUDY DESIGN
A prospective observational study.
PATIENTS AND METHODS
All patients receiving ACP during 20 months in the operative period.
RESULTS
Twenty-three patients were treated by ACP. The origin of sepsis was peritonitis (n = 14), infected pancreatitis (n = 3), mediastinitis (n = 2), one urologic sepsis, one facial cellulitis, one catheter related infection, and one postoperative pneumonia. In two cases, the peritonitis was associated with a pleuretic infection, and in two other cases with parietal cellulites. Mean age was 69+/-13 years. Severities evaluated by SAPS II, LODS were 59+/-13 and 7+/-3, respectively. Mean number organ dysfunction was 3.3+/-1.0. Septic shock was present in 91% with concomitant use of catecholamines for a mean period of 87+/-64 hours. Bacteraemia was present in 43% of the patients. A treatment with hydrocortisone was associated in 52% of the patients. The ICU and hospital lengths of stay were 15+/-16 days, and 34+/-38 days, respectively. Mortality at day 28 was 35%. Two significant bleeding were observed, one requiring red blood cell transfusion and the other one a surgical control of the bleeding associated with red blood cell transfusion.
CONCLUSION
With global management of severe sepsis, including the use of activated C Protein, this prospective observational study showed a 30% reduction of the predicted mortality by SAPS II scoring without significant increase of bleeding episodes in a surgical context.
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