Open Access Emergency Medicine (Oct 2018)
Potential mortality and cost reduction in adult severe sepsis and septic shock through the use of an innovative fluid delivery device
Abstract
Elizabeth A Brooks,1 Mark Piehl2–4 1Health Economics, TTi Health Research and Economics, Hampstead, MD, USA; 2410 Medical, Durham, NC, USA; 3Pediatric Critical Care, WakeMed Children’s Hospital, Raleigh, NC, USA; 4Department of Pediatrics, University of North Carolina Chapel Hill, Chapel Hill, NC, USA Background: While early fluid resuscitation has been shown to significantly improve health and economic metrics in septic shock, providers are often unable to achieve fluid delivery guidelines using current techniques.Purpose: To examine expected clinical and economic consequences of more consistent achievement of fluid resuscitation guidelines through use of a novel fluid delivery technology.Patients and methods: A decision analytic model was developed to compare expected costs and outcomes associated with the standard technique vs a novel, faster technique for rapid fluid resuscitation in adult patients with severe sepsis or septic shock.Results: Use of an innovative fluid delivery device (LifeFlow) resulted in lower expected mortality compared to standard intravenous fluid delivery methods (reduction of 10 fewer deaths per 500 cases). Compared to standard methods, use of the innovative rapid fluid delivery device also resulted in lower expected hospital costs (US$1,569,131 cost reduction per 500 cases), a lower required use of mechanical ventilation (24% vs 31%), decreased average length of stay (11 vs 13 days), decreased average intensive care unit length of stay (2 vs 3 days), and decreased use of vasopressors (17% vs 21%). A sensitivity analysis showed that utilization of the rapid fluid delivery device is more cost-effective than standard methods, even under the most conservative assumptions.Conclusion: Based on existing data supporting the importance of early, controlled fluid resuscitation in septic shock patients, the analytical model developed in this study demonstrated the benefit of a novel device that facilitates earlier fluid bolus completion and better adherence to sepsis bundles. Keywords: sepsis syndrome, sepsis bundles, fluid administration, surviving sepsis campaign, resuscitation
