Portuguese network data: compliance with the Surviving Sepsis Campaign bundles

Introduction

In the context of the worldwide ongoing Surviving Sepsis Campaign (SSC) we decided to characterize community-acquired sepsis (CAS) of our country, using a Portuguese ICU network. We intend to show compliance with the SSC bundles.

Methods

A prospective multicentre nationwide study on community-acquired sepsis in Portuguese ICUs was created in 2004. Seventeen units came together in this project, which lasted from 1 December 2004 until 30 November 2005. During this period data collection included epidemiological characteristics and comorbidities, the community-acquired sepsis episode (locale of infection, responsible organism, first intention antibiotherapy and associated organ dysfunction) and the compliance with the SSC bundles and recommendations.

Results

During this period 2643 patients were included and 606 had CAS (23%). Five hundred and twenty patients (20%) had severe sepsis/septic shock:

• 59% had serum lactate measured (median time from hospital admission and serum lactate measurement was 6.58 hours) and 65% had fluids administered to get a mean arterial pressure of 65 mmHg in the first 6 hours of hospital admission;

• 92% had blood cultures done (median time from hospital admission and blood cultures done was 8.6 hours) and 49% had antibiotics administered in the first hour after sepsis diagnosis (median time from hospital admission and antibiotherapy administration was 5.08 hours);

• 80% had started glucose control measures, 91% had ventilation programmed to achieved a plateau pressure <30 cmH₂O and 6% had drotrectogina administered in the first 24 hours of hospital admission.

Two hundred and eighty patients had septic shock:

• 49% had CVP measured, 14% had SvcO₂ measured, 81% had vasopressors administered and 56% had inotropes in the first 6 hours of hospital admission;

• 53% had low-dose corticoids administered in the first 24 hours of hospital admission.

Discussion

We have a heterogeneous reality on CAS cases admitted to the ICU. We planned courses on sepsis and severe infection centred on SSC recommendations pretending to improve clinical practice. Organizational rearrangements on Emergency Departments are needed to improve SSC recommendation compliance.