Adherence to international guidelines on early management in severe sepsis and septic shock
Abstract
Introduction. Complete adherence to early goal-directed therapy has shown a significant reduction in28-day mortality rate, whereas partial adherence has not shown beneficial effect.
Objectives. The effect of adherence to 6 hour sepsis bundle treatment was evaluated on patients withsevere sepsis and septic shock.
Materials and methods. A prospective cohort study was conducted during a six-month period. Thepatients were limited to those 16 years or older and included admissions to intensive care units, specialcare units or emergency departments with severe sepsis or septic shock. The adherence to the 6-hoursepsis bundle was evaluated through 8 interventions as follows: (1) serum lactate measure,( 2) earlyantibiotic administration, (3) blood culture samples, (4) infusion of intravenous fluids, (5) vasopressoruse, (6) central venous catheter, (7) central venous pressure >8 mm Hg, and (8) central venous oxygensaturation >70%.
Results. Seven hundred and twenty three patients were screened; 16% (n=116) met the inclusioncriteria; 92.2% (n=107) met the criteria for severe sepsis and 37.9% (44) for septic shock; 62.9% (n=73)were subdiagnosed. Complete adherence to the 8 interventions of 6-hour sepsis bundle was 0%; 6 to7 (19%, n=22), 3 to 5 (67.2%, n=78), and 0 to 2 (98.3%, n=114).
Conclusion. Adherence to 6-hour sepsis bundle treatment for severe sepsis and septic shock was notdone for the full 8 interventions and only partial accomplishment of the first 4 interventions.
doi: http://dx.doi.org/10.7705/biomedica.v32i3.349
Downloads
References
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303-10.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250-6.http://dx.doi.org/10.1097/01.CCM.0000050454.01978.3B
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296-327. http://dx.doi.org/10.1097/01.CCM.0000298158.12101.41
Ferrer R, Artigas A, Levy MM, Blanco J, González-Díaz G, Garnacho-Montero J, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA. 2008;299:2294-303. http://dx.doi.org/10.1001/jama.299.19.2294
Dellinger RP, Vincent JL. The Surviving Sepsis Campaign sepsis change bundles and clinical practice. Crit Care. 2005;9:653-4. http://dx.doi.org/10.1186/cc3952
Brunkhorst FM, Engel C, Ragaller M, Welte T, Rossaint R, Gerlach H, et al. Practice and perception a nationwide survey of therapy habits in sepsis. Crit Care Med. 2008;36:2719-25. http://dx.doi.org/10.1097/CCM.0b013e318186b6f3
Gao F, Melody T, Daniels DF, Giles S, Fox S. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: A prospective observational study. Crit Care. 2005;9:R764-70. http://dx.doi.org/10.1186/cc3909
Jones AE, Focht A, Horton JM, Kline JA. Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock. Chest. 2007;132:425-32. http://dx.doi.org/10.1378/chest.07-0234
Trzeciak S, Dellinger RP, Abate NL, Cowan RM, Stauss M, Kilgannon JH. Translating research to clinical practice: A 1-year experience with implementing early goal-directed
therapy for septic shock in the emergency department. Chest. 2006;129:225-32. http://dx.doi.org/10.1378/chest.129.2.225
Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, et al. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med. 2007;35:1105-12. http://dx.doi.org/10.1097/01.CCM.0000259463.33848.3D
Rodríguez F, Barrera L, De La Rosa G, Dennis R, Dueñas C, Granados M, et al. The epidemiology of sepsis in Colombia: A prospective multicenter cohort study in ten university hospitals. Crit Care Med. 2011;39:1675-82. http://dx.doi.org/10.1097/CCM.0b013e318218a35e
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128-40. http://dx.doi.org/10.1016/0196-
(88)90053-3
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-77.
Kortgen A, Niederprum P, Bauer M. Implementation of an evidence-based “standard operating procedure” and outcome in septic shock. Crit Care Med. 2006;34:943-9. http://dx.doi.org/10.1097/01.CCM.0000206112.32673.D4
Shapiro NI, Howell MD, Talmor D, Lahey D, Ngo L, Buras J, et al. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med. 2006;34:1025-32. http://dx.doi.org/10.1097/01.CCM.0000206104.18647.A8
Micek ST, Roubinian N, Heuring T, Bode M, Williams J, Harrison C, et al. Before-after study of a standardized hospital order set for the management of septic shock. Crit Care Med. 2006;34:2707-13. http://dx.doi.org/10.1097/01.CCM.0000241151.25426.D7
El Solh AA, Akinnusi ME, Alsawalha LN, Pineda LA. Outcome of septic shock in older adults after implementation of the sepsis “bundle”. J Am Geriatr Soc. 2008;56:272-8. http://dx.doi.org/10.1111/j.1532-5415.2007.01529.x
Mikkelsen ME, Gaieski DF, Goyal M, Miltiades AN, Munson JC, Pines JM, et al. Factors associated with nonadherence to early goal-directed therapy in the ED. Chest. 2010;138:551-8. http://dx.doi.org/10.1378/chest.09-2210
Marshall JC, Dellinger RP, Levy M. The Surviving Sepsis Campaign: A history and a perspective. Surg Infect (Larchmt). 2010;11:275-81. http://dx.doi.org/10.1089/sur.2010.024.
Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38:367-74. http://dx.doi.org/10.1097/CCM.0b013e3181cb0cdc
Teles JM, Silva E, Westphal G, Filho RC, Machado FR. Surviving sepsis campaign in Brazil. Shock. 2008;30:47-52. http://dx.doi.org/10.1097/SHK.0b013e318181a128
Cardoso T, Carneiro AH, Ribeiro O, Teixeira-Pinto A, Costa-Pereira A. Reducing mortality in severe sepsis with the implementation of a core 6-hour bundle: Results from the Portuguese community-acquired sepsis study (SACiUCI study). Crit Care. 2010;14:R83. http://dx.doi.org/10.1186/cc9008
Some similar items:
- Luis Miguel Sosa, Luz Libia Cala, Julio César Mantilla, Congenital tuberculosis associated with maternal disseminated miliary tuberculosis , Biomedica: Vol. 27 No. 4 (2007)
- Hollman Miller, Gerzaín Rodríguez, Tungiasis in native Amerindians in Vaupés province: epidemiology, clinical aspects, treatment, and prevention , Biomedica: Vol. 30 No. 2 (2010)
- Fabián Jaimes, Gisela de la Rosa, Anticoagulation and sepsis: the opportunity for a new use of heparin?. , Biomedica: Vol. 26 No. 1 (2006)
- Mónica Alejandra Bernal-Vargas, Jorge Alberto Cortés, Ricardo Sánchez, Cross-cultural adaptation of the community-acquired pneumonia score questionnaire in patients with mild-to-moderate pneumonia in Colombia , Biomedica: Vol. 37 No. 1 (2017)
- Azucena Arévalo, William Alberto Otero, Alba Alicia Trespalacios, Helicobacter pylori: Multiple resistance in patients from Bogotá, Colombia , Biomedica: Vol. 39 No. Sp. 1 (2019): Suplemento 1, Microbiología médica, mayo
- Natalia Vélez-Tirado , Lina Castaño-Jaramillo , Sonia Restrepo-Gualteros , Catalina Alcalá-Lozano, Erika Ruge , Carolina Puente , Diana Li-Zeng , Diego Chaparro-Arce , María Camila Beltrán-Dimas , Juan Francisco López , Miguel Luengas-Monroy , Diego Galvis-Trujillo , Iván Gutiérrez-Tobar , Pablo Vásquez-Hoyos , Germán Camacho-Moreno , Severe adenovirus infection outbreak in Colombia: Experience from a tertiary pediatric hospital in 2022 , Biomedica: Vol. 44 No. 1 (2024)
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
