Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock

Michael A. Puskarich, Stephen Trzeciak, Nathan I. Shapiro, Alan C. Heffner, Jeffrey Kline, Alan E. Jones

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

Introduction: We sought to compare the outcomes of patients with cryptic versus overt shock treated with an emergency department (ED) based early sepsis resuscitation protocol. Methods: Pre-planned secondary analysis of a large, multicenter ED-based randomized controlled trial of early sepsis resuscitation. All subjects were treated with a quantitative resuscitation protocol in the ED targeting 3 physiological variables: central venous pressure, mean arterial pressure and either central venous oxygen saturation or lactate clearance. The study protocol was continued until all endpoints were achieved or a maximum of 6. h. Outcomes data of patients who were enrolled with a lactate ≥4. mmol/L and normotension (cryptic shock) were compared to those enrolled with sustained hypotension after fluid challenge (overt shock). The primary outcome was in-hospital mortality. Results: A total of 300 subjects were enrolled, 53 in the cryptic shock group and 247 in the overt shock group. The demographics and baseline characteristics were similar between the groups. The primary endpoint of in-hospital mortality was observed in 11/53 (20%, 95% CI 11-34) in the cryptic shock group and 48/247 (19%, 95% CI 15-25) in the overt shock group, difference of 1% (95% CI -10 to 14; log rank test p=0.81). Conclusion: Severe sepsis with cryptic shock carries a mortality rate not significantly different from that of overt septic shock. These data suggest the need for early aggressive screening for and treatment of patients with an elevated serum lactate in the absence of hypotension.

Original languageEnglish (US)
Pages (from-to)1289-1293
Number of pages5
JournalResuscitation
Volume82
Issue number10
DOIs
StatePublished - Oct 2011
Externally publishedYes

Fingerprint

Resuscitation
Shock
Sepsis
Hospital Emergency Service
Lactic Acid
Hospital Mortality
Hypotension
Central Venous Pressure
Septic Shock
Arterial Pressure
Randomized Controlled Trials
Demography
Oxygen
Mortality
Serum

Keywords

  • Lactate
  • Mortality
  • Resuscitation
  • Sepsis
  • Septic shock

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock. / Puskarich, Michael A.; Trzeciak, Stephen; Shapiro, Nathan I.; Heffner, Alan C.; Kline, Jeffrey; Jones, Alan E.

In: Resuscitation, Vol. 82, No. 10, 10.2011, p. 1289-1293.

Research output: Contribution to journalArticle

Puskarich, Michael A. ; Trzeciak, Stephen ; Shapiro, Nathan I. ; Heffner, Alan C. ; Kline, Jeffrey ; Jones, Alan E. / Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock. In: Resuscitation. 2011 ; Vol. 82, No. 10. pp. 1289-1293.
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