[Activated protein C treatment: experience about 23 patients in the operative period].
OBJECTIVE
To evaluate the use of activated C protein (ACP) in a Surgical Intensive Care Unit.


METHODS
A prospective observational study.


METHODS
All patients receiving ACP during 20 months in the operative period.


RESULTS
Twenty-three patients were treated by ACP. The origin of sepsis was peritonitis (n = 14), infected pancreatitis (n = 3), mediastinitis (n = 2), one urologic sepsis, one facial cellulitis, one catheter related infection, and one postoperative pneumonia. In two cases, the peritonitis was associated with a pleuretic infection, and in two other cases with parietal cellulites. Mean age was 69+/-13 years. Severities evaluated by SAPS II, LODS were 59+/-13 and 7+/-3, respectively. Mean number organ dysfunction was 3.3+/-1.0. Septic shock was present in 91% with concomitant use of catecholamines for a mean period of 87+/-64 hours. Bacteraemia was present in 43% of the patients. A treatment with hydrocortisone was associated in 52% of the patients. The ICU and hospital lengths of stay were 15+/-16 days, and 34+/-38 days, respectively. Mortality at day 28 was 35%. Two significant bleeding were observed, one requiring red blood cell transfusion and the other one a surgical control of the bleeding associated with red blood cell transfusion.


CONCLUSIONS
With global management of severe sepsis, including the use of activated C Protein, this prospective observational study showed a 30% reduction of the predicted mortality by SAPS II scoring without significant increase of bleeding episodes in a surgical context.
Maurice
A
A
Service de réanimation chirurgicale, CHU Pontchaillou, 2, rue Henri-Le-Guillou, 35033 Rennes cedex 09, France. axelle.maurice@chu-rennes.fr
Seguin
P
P
Aguillon
D
D
Chanavaz
C
C
Mallédant
Y
Y
D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy; D002395:Catecholamines / Q000627:therapeutic use; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D011486:Protein C / Q000009:adverse effects / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000209:etiology / Q000517:prevention & control
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D002395:Catecholamines; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated; D006854:Hydrocortisone