Agree with you completely Sean, well summarized.
From: [email protected]
[mailto:[email protected]] On Behalf Of
Townsend, Sean, M.D.
Sent: Wednesday, May 01, 2013 2:47 PM
To: Ram Parekh
Cc: [email protected]
Subject: Re: [Sepsis Groups] Noninvasive EGDT
Did you happen to know that all patients in that trial received a
central line and that CVP was optimized using it? I think therefore we
can't call that trial "non-invasive."
Also, although that trial enrolled 300 patients, the intervention did
not differ until the level of optimizing ScvO2, i.e. all patients that
benefited from CVP, a fluid bolus, antibiotics etc. and met targets
progressively dropped out of the running to actually compare lactate
clearance to ScvO2. Thus, in the end, 29 patients got a head to head
comparison of lactate clearance to ScvO2 optimization.
This would suggest that enrollment in the trial should have been 3000
patients in order to test the actual difference in intervention at the
power requirement of 300.
One can make the argument reasonably that the assertion of
non-inferiority is underpowered by a factor of 10.
One must also wonder about extraordinarily high lactates. None were
enrolled in the trial. So, if I have a lactate of 9 and clear it by 10%
to 8.1 should I be comfortable that I have hit my resuscitation targets?
Doesn't make me so comfortable.
Sean R. Townsend, M.D.
Vice President of Quality & Safety
California Pacific Medical Center
2330 Clay Street, #301
San Francisco, CA 94115
email [email protected]
office (415) 600-5770
fax (415) 600-1541
From: [email protected]
[mailto:[email protected]] On Behalf Of Ram
Parekh
Sent: Tuesday, April 30, 2013 1:50 PM
To: Vipul Kella
Cc: [email protected]
Subject: Re: [Sepsis Groups] Noninvasive EGDT
We have at our hospital and at most of the GNYHA hospitals in the New
York area.
This protocol is based on the non-inferiority study of lactate clearance
by Jones/Shapiro and was implemented with our current Stop Sepsis
collaborative which has given ED providers the option of utilizing the
'invasive' or 'non-invasive protocol' as EGDT options. Thus, the
protocol was simultaneously implemented in over 50 hospitals at the same
time.
On Mon, Apr 29, 2013 at 9:57 AM, Vipul Kella <[email protected]>
wrote:
Has anyone implemented the noninvasive EGDT protocol at their hospital?
What was your experience?
--
Vipul Kella, MD FACEP
Medical Emergency Professionals (MEP)
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