Impact of the sepsis bundle strategy on the outcomes of the patients suffering from severe sepsis and septic shock

Introduction

Patients suffering from severe sepsis and septic shock have a high mortality. Studies have demonstrated that the septic bundle strategy decreased the mortality of severe sepsis and septic shock. The aim of this study was to compare the impact of the sepsis bundle strategy on the outcomes of the patients suffering from severe sepsis and septic shock in our emergency department.

Methods

A prospective study was performed. The studied population included severe sepsis and septic shock patients entered into the Surviving Sepsis Campaign (SSC) database, who were admitted to the emergency department of an urban tertiary-care medical center during June 2008 to June 2009. They were divided into two groups based on the admission time (Group 1: June 2008 to December 2008, baseline survey of real practice in sepsis therapy before creating a protocol. Group 2: January 2009 to June 2009, creating a protocol implementing sepsis resuscitation bundle in sepsis therapy). Acute Physiology and Chronic Health Evaluation (APACHE II) scores, treatments and in-hospital mortality were compared.

Results

The timing giving broad-spectrum antibiotics of ED admission was 3.67 hours in Group 1 and 2.52 hours in Group 2 (P < 0.01). Blood cultures before antibiotics administration was 39.7% in Group 1 and 56.3% in Group 2 (P < 0.01). Fluid bolus (20 ml/kg) delivered followed by vasopressors if needed was 27% in Group 1 and 76% in Group 2 (P < 0.01). In-hospital mortality was 44.8% in Group 1 and 35.6% in group, in-hospital mortality decreased by 9.2% (P < 0.01).

Conclusions

Creating a protocol implementing sepsis bundles improved compliance for the bundle strategy on the treatment of severe sepsis and septic shock and decreased in-hospital mortality.