Standard operating procedure in patients with severe sepsis and septic shock

Introduction

Patients with severe sepsis and septic shock still have a high mortality rate, despite improvements in intensive care therapy. In the present study we assessed the impact of a standard operating algorithm adjusted on international treatment recommendations in patients with severe sepsis and/or septic shock (for example, volume resuscitation, hemodynamic control, glycemic control, substitution of selenium and/or hydrocortisone and the use of recombinant human activated protein C (rhAPC)) on the outcome.

Methods

A retrospective analysis of 144 patients admitted to our medical ICU in 2004 and 2006. In 2004, before implementation of the standard operating procedure (SOP), 74 patients fulfilling criteria for diagnosis of severe sepsis and/or septic shock were analysed and compared with 70 patients after implementation of evidence-based SOP in 2006.

Results

Both groups did not show any difference in initial APACHE II score and clinical baseline characteristics. With implementation of the SOP, use of volume in the first 6 hours (1,506 vs. 2,154 ml, P < 0.05) and in the first day (4,005 vs. 6,122 ml, P < 0.001) significantly increased. Furthermore, treatment with hydrocortisone, selenium and insulin increased after implementation of the SOP significantly. Catecholamines and rhAPC were unaffected. Mortality in the patient group without SOP was 57%, and in the intervention group with SOP the mortality was 38.5% (P < 0.05).

Conclusion

Owing to the implementation of a standard algorithm, a significant increase in volume therapy and adjunctive sepsis therapy were realised more frequently compared with patients treated without the SOP and could be associated with a lower mortality rate in patients. The realisation of an evidence-based SOP in daily practice in patients with severe sepsis and/or septic shock might be effective, shown in the alteration of treatment practice and the reduction of mortality.