title: Lower initial central venous pressure in septic patients from long-term care facilities than in those from the community.
abstract: OBJECTIVE
  The cornerstone of emergency management of severe sepsis and septic shock is early (within 6 hours) goal-directed therapy, including maintenance of central venous pressure (CVP) at 8-12 mmHg. It is unclear whether there is a difference in initial (baseline) CVP between septic patients who are referred from the community and those who come from long-term care facilities (LTCFs) in Taiwan. We designed this study to investigate the difference in hemodynamic parameters between these two groups.
  
  
  METHODS
  Every patient with severe sepsis or septic shock who had a central venous catheter inserted via the internal jugular or subclavian vein at Kaohsiung Medical University Hospital between April 2007 and October 2007 was enrolled. CVP was measured immediately at the emergency department. Patient demographics, including residence, were retrospectively recorded and analyzed.
  
  
  RESULTS
  There were 166 evaluable patients; 125 (75.3%) came from the community and 41 (24.7%) from LTCFs. There were no significant differences in age, sex, initial body temperature, heart rate, blood pressure, or leukocyte count between the two groups. However, patients who were referred from LTCFs had a significantly lower initial CVP than those from the community (5.0 ± 4.5 mmHg vs. 7.0 ± 4.8 mmHg, p = 0.023). The difference was more significant between mechanically ventilated patients from LTCFs and those from the community (5.0 ± 3.0 mmHg vs. 8.1 ± 5.6 mmHg, p = 0.006).
  
  
  CONCLUSIONS
  Severely septic patients referred from LTCFs may require more aggressive fluid resuscitation within the first 6 hours of the diagnostic criteria met at the emergency department to achieve the CVP target of early goal-directed therapy.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Tun-Chieh
authors.initials: TC
authors.lastname: Chen
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
authors.affiliation: Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Hui-Juan
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Royal Victoria Teaching Hospital, Banjul, Gambia.
authors.forename: Kebba S
authors.initials: KS
authors.lastname: Bojang
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: infchen@gmail.com.
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002496:Central Venous Pressure; D017714:Community-Acquired Infections / Q000473:pathology* / Q000628:therapy; D003428:Cross Infection / Q000473:pathology* / Q000628:therapy; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000473:pathology* / Q000628:therapy; D013624:Taiwan
keywords: Central venous pressure; Long-term care; Resuscitation; Sepsis