Survival sepsis campaign bundles, compliance and mortality: prospective single-center study
© BioMed Central Ltd 2008
Published: 13 March 2008
Sepsis is a major problem in healthcare, with high mortality. Application of surviving sepsis campaign evidence-based recommendations is a way of improving quality of care.
Concurrent data collection for all patients admitted to an ICU with the diagnosis of community-acquired severe sepsis (including septic shock), between 2005 and 2007. Time zero was defined as the hospital arrival time.
During that period 228 patients were admitted to the study, median age was 60 years, 62% were male, the median SAPS II score was 45 and 63% had septic shock. The overall mortality rate was 36%. Compliance with 6-hour bundles was: 54% for serum lactate measurement, 39% for blood cultures 18% for antibiotic administration in 1 hour, 98% for fluid challenge, 34% for central venous pressure >8 cmH2O and 4% for SvcO2 >70%. The overall compliance was 1%. The median time from hospital to ICU admission was 6 hours (P25 = 1; P75 = 25). Compliance with 24-hour bundles was 59% for steroids in refractory septic shock, 51% for glucose control < 150 mg/dl and 98% for plateau pressure < 30 cmH2O. The overall compliance was 37%. Logistic regression was built with 28-day outcome as the end point, adjusted for age (OR = 1.035; 95% CI = 1.017–1.054), gender and severity of sepsis (septic shock OR = 3.241; 95% CI = 1.734–6.056) and SAPS II (OR = 1.046; 95% CI = 1.026–1.067), for each of the 6-hour and 24-hour bundles. Only the use of corticoids, in refractory shock had a significant reduction on 28-day mortality (adjusted OR = 0.45; 95% CI = 0.214–0.946). Lactacidemia was found to be an independent risk factor for 28-day mortality (adjusted OR = 1.276; 95% CI = 1.083–1.504).
The rate of compliance with the 6-hour sepsis bundle was very low and the main reasons were the early antibiotic administration and the measurement of central venous saturation. This compliance rate would probably be better if we had considered time zero the time of the diagnosis but objectivity would be lost. In conclusion, there is a large need for improvement in the care of the severe septic patient in our hospital, mainly in the emergency department where compliance is lower. Lactacidemia seems to be a good index of prognosis.
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