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I've been doing some research for my programs sepsis protocol concerning Xigris use. It appears that there is evidence for use in APACHE >25 and multiple organ failure, and not to use in single organ failure or APACHE <25 in the PROWESS, ENHANCE, and ADDRESS trials. A recent article in NEJM 12/31/09 seems to agree.
The question that keeps coming up and for which the evidence seems shaky is: Should Xigris be initiated in a patient that arrives in Septic Shock no other organ dysfunction/no worsening organ dysfunction or in Severe Sepsis w/ ARDS other organ dysfunction/no worsening organ dysfunction.
The problem is these are higher mortality than severe sepsis w/ SOD and are likely to progress to MOD, and studies show that the sooner Xigris is administered, the better. Some of the ICU attending at my institution flat say no xigris in anybody, and some say give in all the 4 I mentioned above.
Any thoughts?
Already searched the forum, no good answers
The question that keeps coming up and for which the evidence seems shaky is: Should Xigris be initiated in a patient that arrives in Septic Shock no other organ dysfunction/no worsening organ dysfunction or in Severe Sepsis w/ ARDS other organ dysfunction/no worsening organ dysfunction.
The problem is these are higher mortality than severe sepsis w/ SOD and are likely to progress to MOD, and studies show that the sooner Xigris is administered, the better. Some of the ICU attending at my institution flat say no xigris in anybody, and some say give in all the 4 I mentioned above.
Any thoughts?
Already searched the forum, no good answers
