Sepsis bundles: just think about it?

Introduction

The aim of the study is to verify the impact of the implementation of the diagnostic and therapeutic bundles suggested by Sepsis Surviving Campaign (SSC) [1] on the outcome of patients with severe sepsis and septic shock.

Methods

A retrospective analysis of the outcome of severe sepsis and septic shock patients before, during and after the implementation of the bundles according to the SSC in an eight-bed polyvalent ICU. We evaluated ICU and hospital mortality, the length of stay, the level of compliance to the bundles and its impact on the mortality. Statistical analysis was performed using the chi-square test.

Results

A total of 127 patients were enrolled from 2005 onwards (38 patients in 2005, 43 patients in 2006 and 46 patients in 2007). We observed a reduction of the overall ICU and hospital mortality from 73% to 43%, not statistically significant, even if the difference between the observed and predicted mortality showed a statistically significant improvement (P = 0.027) (Figure 1). On the contrary, the length of stay [2] was 18 days in 2005, 23 days in 2006, 25 days in 2007. Our compliance was respectively 59% in 2006 and 55% in 2007 for resuscitation bundles and 58% in 2006 and 78% in 2007 for management bundles. The mortality was higher (70%) in the group with an overall compliance score ≤ 6 compared with 40% for those with a score ≥ 7.

Figure 1

Severe sepsis and septic shock hospital mortality.

Conclusion

Even though the main difficulty was to timely reach the targets of the bundles, the existence of a protocolized approach to severe sepsis and septic shock seems to contribute to the reduction of mortality in our population of patients.