Edwards Oximetry CVC and Other Hemodynamic Monitors May Help Address Sepsis Mortality in California


In Sepsis

Get Dexur’s Personalized Hospital Specific Presentation on Quality, Safety, Compliance & Education


By: James Pitt  May. 04, 2018

Sepsis is a common and severe complication of infection. It is involved in up to half of all in-hospital deaths. Sepsis occurs when the immune system responds to infection by causing a systemic inflammatory response.This in turn can cause widespread damage, including acute lung injury.

To determine current unmet needs, Dexur analysts examined sepsis mortality at five hospitals in California with the largest number of sepsis inpatients in 2013-2016 CMS claims data, at DRG level. DRG 870 includes sepsis patients who required 96+ hours of mechanical ventilation. DRG 871 includes sepsis patients who had major complications or comorbidities but did not require 96+ hours of mechanical ventilation.

The mortality gap between patients who did and did not require long-term mechanical ventilation is striking. One reason for this gap may be positive fluid balance, which predicts higher sepsis mortality and predicts need for mechanical ventilation in patients with acute lung injury.

Fluid administration is essential for sepsis patients. As the Surviving Sepsis Campaign (SSC) guidelines state, “Early effective fluid resuscitation is crucial for stabilization of sepsis-induced tissue hypoperfusion or septic shock.” But afterwards, positive fluid balance increases risk of death. To keep fluid balance in a safe range, the SSC recommends hemodynamic monitoring.

Devices such as the Edwards oximetry central venous catheter can monitor two important correlates of fluid balance, central venous pressure (CVP) and central venous oxygen saturation (ScvO2). The SCC recommends monitoring these metrics in patients at risk of progressing to septic shock. The Edwards oximetry device meets recommendations for placing a central line when giving vasopressors, which are used after fluid replacement.

Per the SSC 2016 update, “Overall hospital mortality decreased 0.7% for every 3 months a hospital participated in the SSC, associated with a 4% decreased LOS [length of stay] for every 10% improvement in compliance with bundles.” Monitoring fluid balance to adhere to the SSC guidelines may help providers reduce sepsis mortality.

DEXUR PRO MEMBERS GET ACCESS TO:

  1. Discharges and mortality rates for patients with DRGs 870 or 871 at Cedars-Sinai Medical Center (Los Angeles), Hoag Memorial Hospital Presbyterian (Newport Beach), Dignity Health - Marian Regional Medical Center (Santa Maria), Methodist Hospital of Southern California (Arcadia), and Providence Tarzana Medical Center (Tarzana).

ABOUT THE AUTHOR

No Image

James Pitt

James Pitt is a science writer with experience in medical devices and textbook publishing. His hobbies include reading, flintknapping, and squinting at RStudio. He received a bachelor's in Human Evolutionary Biology from Harvard.