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Sama By Andrew E. Sama, MD, FACEP With nearly two-thirds of all admitted septic patients presenting to the ED, and with the clear time sensitivity that exists between recognition, treatment, and outcomes, our members are on the front lines to save lives from this frequently fatal disease.
A few years later, the measure was initially zexting by the NQF in without the requirement for a central line for the emergency department. While it is certain that early intervention does reduce mortality, not all elements of the sepsis composite bundle were equally evidence-based.
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Many studies over the years have demonstrated dramatic improvements in sepsis-related mortality after the implementation of early interventions for septic patients, which included early antibiotic administration, source control, and aggressive fluid resuscitation without invasive monitoring of CVP and ScVO2. One study addressing this, authored by Dr.
Alan Jones and colleagues, was conducted at three EDs in the US, and compared two protocols that both included central tourm pressure measurement; however, one used lactate clearance and the other used central venous oxygenation monitoring as a way to guide resuscitation. In the measure underwent routine NQF maintenance review for re-endorsement in Nonetheless, the NQF endorsed the requirement for the central line, noting that they would re-consider if additional evidence warranted it.
During the review, one of the PIs, Donald Yealy, MD, FACEP engaged in a scientific debate noting that the ProCESS trial enrolled 1, patients, with a power to detect a percent absolute difference, yet demonstrated no difference in mortality day mortality day mortality, one year mortality, or the need for organ support.
The ProCESS also noted no benefit in any outcome when using CVC- guided care and the simpler approaches that sextihg early and ongoing care produced the same good outcomes. CMS, NQF, and others are now also convinced that honing the sepsis bundle is a move forward for tourm septic patients, with or without invasive monitoring depending on the progression of their disease, their unique circumstances, and the resources available at the ED where they are being treated.
We look forward to continuing to work with the measure developer to ensure that all septic patients receive the timely, effective care they need, and to continue to save lives from this deadly disease. You can follow any responses to foufm entry through RSS 2. You can skip to the end and leave a response.
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