title: Community-acquired septic shock: early management and outcome in a nationwide study in Finland.
abstract: OBJECTIVE
  To determine how the early treatment guidelines were adopted, and what was the impact of early treatment on mortality in septic shock in Finland.
  
  
  METHODS
  This study was a sub-analysis of a prospective observational investigation of severe sepsis and septic shock in Finland (Finnsepsis). All patients with severe sepsis over 4 months in 24 intensive care units were included in the Finnsepsis study. Patients with community-acquired septic shock, admitted directly from the emergency department to the intensive care unit, were included in the sub-study. The following treatment targets were evaluated: measurement of lactate during the first 6 h; analysis of blood culture before antibiotics; commencement of antibiotics within 3 h; attainment of a mean arterial pressure of > or =65 mmHg, central venous pressure of > or =8 mmHg and central venous oxygen saturation of > or =70% or mixed venous oxygen saturation of > or =65% during the first 6 h.
  
  
  RESULTS
  Of the 92 patients who fulfilled the inclusion criteria, six reached all treatment targets and 33 reached four or more targets (group > or =4). The hospital mortality of group > or =4 was 24% (8/33), compared with 42% (25/59) for those who reached three or fewer targets (group < or =3) (P= 0.08). The 1-year mortality rates of group > or =4 and group < or =3 were 36% and 59% (P= 0.04), respectively. In logistic regression analysis, a delayed initiation of antimicrobials was associated with an unfavourable outcome (P= 0.04).
  
  
  CONCLUSIONS
  Compliance with international guidelines for the early treatment of septic shock was poor in Finnish hospitals. A failure to diagnose early and to start appropriate treatment was reflected in the high mortality. The delayed start of antibiotics was the most important individual variable leading to a high mortality in this nationwide study.
authors.affiliation: Department of Surgery, Helsinki University Hospital, Helsinki, Finland. marjut.varpula@hus.fi
authors.forename: M
authors.initials: M
authors.lastname: Varpula
authors.forename: S
authors.initials: S
authors.lastname: Karlsson
authors.forename: I
authors.initials: I
authors.lastname: Parviainen
authors.forename: E
authors.initials: E
authors.lastname: Ruokonen
authors.forename: V
authors.initials: V
authors.lastname: Pettilä
mesh_terms: D005387:Finland / Q000453:epidemiology; D006801:Humans; D012772:Shock, Septic / Q000453:epidemiology* / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome