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Abstract

Introduction: Septic shock is heterogeneous and complex in pathogenesis with a mortality of 30-50%, and characterised by extreme and variable cardiovascular function. Septic shock results in a critical oxygen supply-demand mismatch, with therapy directed at reconciling cellular DO2 and VO2 and maintaining cardiovascular homeostasis. Rivers et al. demonstrated reduced mortality from 46% to 32% by goal directing management to BP, CVP, ScvO2 and serum lactate as surrogates of DO2 and VO2. The introduction of accurate non-invasive haemodynamic monitoring (USCOM, Uscom Ltd, Australia) provides rapid direct measurement of hemodynamics, including DO2, which facilitates management of septic shock at presentation. A protocol based on USCOM derived advanced hemodynamics has been introduced at Bathurst Base Hospital, a rural hospital in Australia. Hypothesis: Immediate diagnosis, administration of antibiotics and cardiovascular support directed by advanced non-invasive hemodynamics may improve the management of septic shock. Methods: Data from septic shock patients treated at Bathurst Hospital between 2006 to 2012 were extracted from the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE) database. The database, established to benchmark clinical standards of practice, were analysed for trends in mortality, morbidity and emergency transport to tertiary centres. Results: Since the introduction of the Bathurst-USCOM protocol in 2007, over 80% of studied patients were hemodynamically optimised in less than 60 minutes, and mortality in septic shock patients has fallen by 94% from 13.8 deaths pa to 0.8 deaths pa. Renal failure has fallen from 52.7% to 2.6%, a relative 95% reduction, and emergency transport to tertiary referral centres reduced from 24.6% to 3.2%, a relative reduction of 87%. Mortality over the period significantly correlated with need for transport and renal failure with r = 0.967 and 0.853 respectively (p Conclusions: Immediate identification of septic shock, institution of advanced monitoring, and implementation of appropriate antibiotic and hemodynamic strategies improved early goal directed therapy of septic shock and significantly improved outcomes.