Xigris

I've seen it used recently for severe sepsis in conjunction with other things of coorifice. This patient ultimately was transferred to a lower level of care. It's hard to tell the role that Xigris played in treatment and the extent to which it helped because of the other treatment modalities being used, but in this case it certainly didn't seem to "hurt" the patient at all.

Use it on a routine basis almost.

We use it. But I think we often use it too late. We have a checklist for when it should be used, but it doesnt' get the push it needs. It seems that by the time we pull out this last ditch effort, the patient is too far gone to really save. I would like to see the effect of the med used earlier.

From what I learned in my critical care class, Xigris is only used when the patient is at a high risk for death (septic shock) when a vasopressor needs to be added to maintain their blood pressure (mechanical ventilation is also included in this category)...personally I would like to see this drug used earlier, too...

We have a sepsis protocol where I work in the critical care areas. Patients get lined up, have cultures drawn, broad spectrum antibiotics started, then fluid flushed. If fluid flushes don't resolve the hypotension, they get started on a pressor, and it is at that point that the docs go through a clinical decision-making tool to decide whether or not to use it. There are some contraindications (mainly have to do with bleeding) so it isn't always used, but the protocol we have is timed, so if they meet criteria for use and the docs decide to go for it, it is started within 6 hours of admission. I am not sure about the success rates at my facility, but I think according to the drug manufacturer it does improve outcomes.

We only use it in our severe septic shock patients requiring high vasopressor support either in MOSF or heading in that direction. The most positive results I have seen is when it is started earlier rather than later. Like others have said, I'm not sure if it is the one thing that makes the difference for the patient, as we are doing so many interventions at that point. It seems to be almost like a last ditch effort, when not much more can be ordered or done.

maybe its used so infrequently because of the cost? Ive heard it's more than 5,000 dollars a pop!

There are actually a fair amount of indications and exclusion criteria. It's definitely not a drug that CAN be used on everybody. You have to be in severe sepsis -- and it takes a lot more than just a bad infection to be in severe sepsis -- meaning pressors, perfusion problems, the beginnings of end-organ dysfunction AND you can't have had recent surgery or any type of bleeding for those risks. So that excludes all surgical patients right there, and a lot of other people. I think that is probably why it isn't used that much, besides it is relatively new and not a lot of docs are comfortable with it yet.