Guidelines for Complications of Cancer Treatment Vol VIII Part B

comparisons). During the same period, mean APACHE IIscores were significantly lower, indicating less severe organdysfunction, in the patients assigned to early goal-directedtherapy than in those assigned to standard therapy (13.0+/-6.3 vs. 15.9+/-6.4, P < 0.001). CONCLUSIONS: Early goaldirectedtherapy provides significant benefits with respect tooutcome in patients with severe sepsis and septic shock.PMID: 11794169 [PubMed - indexed for MEDLINE]Kumar A, Roberts D, Wood KE, et al. Duration ofhypotension before initiation of effective antimicrobialtherapy is the critical determinant of survival in humanseptic shock. Crit Care Med. 2006; 34: 1589-96OBJECTIVE: To determine the prevalence and impact onmortality of delays in initiation of effective antimicrobialtherapy from initial onset of recurrent/persistent hypotensionof septic shock. DESIGN: A retrospective cohort studyperformed between July 1989 and June 2004. SETTING:Fourteen intensive care units (four medical, four surgical, sixmixed medical/surgical) and ten hospitals (four academic, sixcommunity) in Canada and the United States. PATIENTS:Medical records of 2,731 adult patients with septic shock.INTERVENTIONS: None. MEASUREMENTS AND MAINRESULTS: The main outcome measure was survival tohospital discharge. Among the 2,154 septic shock patients(78.9% total) who received effective antimicrobial therapyonly after the onset of recurrent or persistent hypotension, astrong relationship between the delay in effective antimicrobialinitiation and in-hospital mortality was noted (adjusted oddsratio 1.119 [per hour delay], 95% confidence interval 1.103-1.136, p