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USE OF RECOMBINANT ACTIVATED PROTEIN C IN GLASGOW INTENSIVE CARE UNITS

USE OF RECOMBINANT ACTIVATED PROTEIN C IN GLASGOW INTENSIVE CARE UNITS. ALEX PUXTY SpR Glasgow Royal Infirmary. BACKGROUND. SICS guidelines (2003) NICE guidelines (2004) ≥ 2 organ failures excluded APACHE II data. Surviving Sepsis Campaign (2004) included APACHE criteria ≥25. OBJECTIVES.

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USE OF RECOMBINANT ACTIVATED PROTEIN C IN GLASGOW INTENSIVE CARE UNITS

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  1. USE OF RECOMBINANT ACTIVATED PROTEIN C IN GLASGOW INTENSIVE CARE UNITS ALEX PUXTY SpR Glasgow Royal Infirmary

  2. BACKGROUND • SICS guidelines (2003) • NICE guidelines (2004) ≥ 2 organ failures excluded APACHE II data. • Surviving Sepsis Campaign (2004) included APACHE criteria ≥25

  3. OBJECTIVES • Determine rAPC usage in Glasgow: • Patient characteristics & outcome • Implementation of other “Surviving Sepsis Campaign” recommendations Method: • Retrospective case note review patients received rAPC in Glasgow 1/8/6 - 31/7/7 • Identified from pharmacy records

  4. DEMOGRAPHICS 44 patients across all hospitals Not evenly spread Median organ failures was three

  5. “JOURNEY OF PATIENTS” • Many of these patients straight from A+E • Significant majority within 2 days of admission

  6. “JOURNEY OF PATIENTS” • Guidelines state that should be given within 48hrs • Some would say that other therapies should be tried first

  7. RECEIVING rAPC: ORGAN FAILURES? All met NICE criteria

  8. RECEIVING rAPC: APACHE II? Surviving sepsis guidelines include APACHE II 36% did not meet this criterion

  9. OUTCOME DATA • EXPECTED MORTALITY: 56.05% • ACTUAL MORTALITY 47.7% • SMR: 0.85

  10. SURVIVING SEPSIS CAMPAIGN • Recommendations regarding OTHER MANAGEMENT TARGETS • Audited against 2004 Guideline

  11. CONCLUSION • By NICE guidelines, all patients who received rAPC qualified • Not by surviving sepsis guidelines • Decision on which to follow • Other interventions have varying degrees of success with implementation

  12. AND NOW FOR……A SHAMELESS PLUG!

  13. FURTHER STUDY • Plan to audit if all patients who qualify receive rAPC • Scotland wide • SICSAG sprint audit • Attached questionnaire on attitude towards rAPC

  14. QUESTIONS?

  15. Some Data Difficult To Ascertain If Measured Blood Cultures Before Abx Difficult To Determine Absence Of ScvO2 MISSING DATA

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