Surviving sepsis campaign guidelines for severe sepsis and septic shock: implementation and outcome of a 3-year follow up

Introduction

The purpose of the study was to describe the effectiveness of the Surviving Sepsis Campaign bundles with regard to both implementation and outcome in patients with septic shock.

Methods

A single-center prospective observational study of patients admitted to the medical–surgical ICU fulfilling criteria for the international sepsis definitions. After a widespread 2-month educational program, implementation of Surviving Sepsis Campaign Resuscitation Bundles (RB) and Management Bundles (MB) were accomplished. A reinforcement educational program was performed in October 2007. Patients were recruited from September 2005 to August 2008.

Results

We analyzed 384 episodes of septic shock. The mean age was 64.5 ± 15 years, APACHE II score 23.2 ± 7.2, Sequential Organ Failure Assessment score 9.5 ± 3, and global hospital mortality 37.5%. The rate of compliance with the RB was 35.4%. There were significant differences in mortality between compliant (C) and noncompliant (NC) groups despite the similar characteristics and the severity of septic shock. The mortality rate was 42.5% in the NC group and 23.6% in the C group. The compliance rate with MB was only 10%, there were no differences in mortality between C and NC groups (41% vs. 37%). When the influence of age, severity, emergency department origin, and ICU admission delay was controlled by multivariate analysis, compliance with RB was independently associated with survival (OR = 0.39, 95% CI = 0.22 to 0.70, P < 0.01). Compliance rates with RB during three consecutive 12-month time periods were 34%, 23% and 45.4%, respectively (P < 0.01); inhospital mortality rates in those periods were 37%, 47% and 31%, respectively (P = 0.03). Compliance with MB decreased from 20% (first period) to 3% (third period).

Conclusion

Implementation of RB was associated with decreased mortality in patients with septic shock. The compliance rate with MB was poor and had no impact on survival.