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Volume 17 Supplement 4

Sepsis 2013

  • Poster presentation
  • Open Access

Impact of the Surviving Sepsis Campaign clinical guideline of in sepsis mortality in a public health institution in Brazil

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Critical Care201317 (Suppl 4) :P4

https://doi.org/10.1186/cc12905

  • Published:

Keywords

  • Severe Sepsis
  • Managerial Measure
  • Survive Sepsis Campaign
  • Public Health Institution
  • Survive Sepsis Campaign Guideline

Background

Sepsis is the principal cause of mortality in intensive therapy units (ITUs) around the world [1]. Several international organizations created in 2002 the Surviving Sepsis Campaign (SSC), targeting the reduction of sepsis mortality in 25% during 5 years [2]. The Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Brazil, was incorporated in this campaign with eight hospitals (four general hospitals, one trauma hospital, one oncologic center, one infectious diseases center, one maternity hospital). The aim of this study is to evaluate the impact of using the SSC sepsis protocol in severe sepsis and sepsis shock lethality in the FHEMIG net hospitals.

Materials and methods

This is a retrospective cohort study based on eight ITU public hospitals. The inclusion criteria were patients with severe sepsis and sepsis shock according to the SSC protocol, from January 2010 to December 2012, aged older than 18 years, which had a final outcome of hospital discharge or death. The sepsis lethality was compared annually from 2010 to 2012. Since 2010, the implementation of educative and managerial measures was based on the SSC guidelines: auditing of medical charts; education in sepsis care; issue of booklet and posters about sepsis; inclusion of sepsis information in the medical residence program; and collaboration of hospital directors in monitoring and giving information of the sepsis guideline. The study was approved by the Institutional Ethical and Research Committee. Data were collected and analyzed on EPIINFO software, using ANOVA test for comparisons with precision of 95%.

Results

In the period of 3 years, 1,698 severe sepsis and sepsis shock patients were registered and 1,152 (67.84%) died. We verified a reduction of 12% (P = 0.0073) on lethality global. Hospitals 2 and 6 had a significant reduction on lethality, of 35% (P < 0.0001) and 17% (P = 0.0073) respectively (Table 1).
Table 1

Severe sepsis and sepsis shock death in the eight FHEMIG hospitals, from 2010 to 2012.

Hospital

2010

2011

2012

P value

 

Number of patients

Death ( n )

Death (%)

Number of patients

Death ( n )

Death (%)

Number of patients

Death ( n )

Death (%)

ANOVA

1

103

62

60.2

120

66

55

94

47

50

0.3578

2

59

52

88.1

114

87

76.3

110

63

57.3

0.0001

3

24

22

91.7

33

26

78.8

34

32

94.1

0.1292

4

68

57

83.8

71

63

88.7

68

54

79.4

0.3270

5

64

50

78.1

63

51

81

76

59

77.6

0.8821

6

94

75

79.8

92

54

58.7

115

76

66.1

0.0070

7

39

31

79.5

56

40

71.4

65

53

81.5

0.3954

8

49

15

30.6

38

10

26.3

49

7

14.3

0.1476

Total

500

364

72.8

587

397

67.6

611

391

64.1

0.0074

Conclusions

The sepsis lethality is still high in this institution (64.1%), compared with the Public Hospitals in Brazil (59.6%) and the world rate (30.8%) [3]. After the adoption of managerial measures based on the SSC protocol, there was a significantly reduction in lethality, but only one hospital reached the target reduction of 25% on lethality. This heterogeneity could be explained by different engagements of the professional board and directory and different patient's profiles. The sepsis mortality is a major challenge in the world [4], and application of the SSC protocol led to a significant reduction in sepsis lethality.

Declarations

Acknowledgements

The authors would like to acknowledge the assistance of the staff and local protocol team of the participant hospitals: Hospital João XXIII, Hospital Alberto Cavalcanti, Hospital Geral de Barbacena, Hospital Júlia Kubitschek, Hospital Eduardo de Menezes, Maternidade Odete Valadares, Hospital Regional João Penido and Hospital Regional Antônio Dias.

Authors’ Affiliations

(1)
Fundação Hospitalar do Estado de Minas Gerais,Comissão Central de Protocolos Clínicos, Belo Horizonte, MG, Brazil

References

  1. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, et al.: International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009, 302: 2323-2329. 10.1001/jama.2009.1754View ArticlePubMedGoogle Scholar
  2. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, et al.: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013, 41: 580-637. 10.1097/CCM.0b013e31827e83afView ArticlePubMedGoogle Scholar
  3. Instituto Latino Americano de Sepse[http://http//www.sepsisnet.org]
  4. Sales Júnior JAL, David CM, Hatum R, Souza PCSP, Japiassú A, Pinheiro CTS, Friedman G, Silva OB, Dias MD, Koterba E, et al.: Sepse Brasil: estudo epidemiológico da sepse em Unidades de Terapia Intensiva brasileiras. Rev Bras Ter Intensiva 2006, 18: 9-17. 10.1590/S0103-507X2006000100003View ArticlePubMedGoogle Scholar

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