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Table 5 Possibility to implement the surviving sepsis campaign guidelines

From: Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providers

   African countries High-income countries P-value
Respondents n 263 44  
Possibility to implement the SSC guidelines in entirety n (%) 4 (1.5) 36 (81.8) <0.001*
Percentage of implementable recommendations/suggestions (%) 72.6 (57.5 to 87.7) 100 (100 to 100) <0.001*
Possibility to implement all Grade 1 recommendations n (%) 15 (5.7) 40 (90.9) <0.001*
Percentage of implementable Grade 1 recommendations (%) 80.8 (63.5 to 88.5) 100 (100 to 100) <0.001*
Possibility to implement all Grade 1A and 1B recommendations n (%) 30 (11.4) 41 (93.2) <0.001*
Percentage of implementable Grade 1A and 1B recommendations (%) 87.5 (70.8 to 95.8) 100 (100 to 100) <0.001*
Possibility to implement all Grade 1C and 1D recommendations n (%) 26 (9.9) 40 (90.9) <0.001*
Percentage of implementable Grade 1C and 1D recommendations (%) 71.4 (57.1 to 89.3) 100 (100 to 100) <0.001*
Possibility to implement all Grade 2 recommendations n (%) 4 (1.5) 36 (81.8) <0.001*
Percentage of implementable Grade 2 recommendations (%) 57.1 (38.1 to 81) 100 (100 to 100) <0.001*
Possibility to implement all sepsis resuscitation bundles n (%) 43 (16.3) 41 (93.2) <0.001*
Bundle element "Lactate" n (%) 64 (24.3) 43 (97.7) <0.001*
Bundle element "Cultures" n (%) 188 (71.5) 44 (100) <0.001*
Bundle element "Antibiotics" n (%) 204 (77.6) 44 (100) <0.001*
Bundle element "Hypotension" n (%) 238 (90.5) 44 (100) 0.03*
Bundle element "CVP/ScvO2" n (%) 70 (26.6) 41 (93.2) <0.001*
Possibility to implement all sepsis management bundles n (%) 12 (4.6) 39 (88.6) <0.001*
Bundle element "Steroids" n (%) 252 (95.8) 44 (100) 0.17
Bundle element "rhAPC" n (%) 15 (5.7) 39 (88.6) <0.001*
Bundle element "Glucose" n (%) 221 (84) 44 (100) 0.004*
Bundle element "Plateau Pressure" n (%) 182 (69.2) 44 (100) <0.001*
  1. SSC, Surviving Sepsis Campaign; *, significant group difference. Data are given as median values with interquartile ranges, if not otherwise indicated. The Surviving Sepsis Campaign categorized their recommendations using the GRADE system which classifies recommendations as strong (grade 1) or weak (grade 2). Furthermore, the system Classifies the quality of evidence as high (grade A), moderate (grade B), low (grade C), or very low (grade D).The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. Sepsis Resuscitation Bundles: Element "Lactate", measurement of serum lactate; Element "Cultures", obtainment of blood cultures prior to antibiotic administration; Element "Antibiotics", administration of broad-spectrum antibiotics within three hours of emergency department admission and within one hour of non-emergency department admission; Element "Hypotension", treatment of hypo-tension and/or elevated lactate with fluids; Element "CVP/ScvO2", maintenance of adequate central venous pressure and central venous oxygen saturation. Sepsis Management Bundles: Element "Steroids", administration of low-dose steroids for septic shock in accordance with a standardized ICU policy; Element "rhAPC", administration of recombinant human activated protein C in accordance with a standardized ICU policy; Element "Glucose", maintenance of blood glucose control lower limit of normal, but <180 mg/dL (10 mmol/L); Element "Plateau Pressure", maintenance of a median inspiratory plateau pressure <30 cmH2O for mechanically ventilated patients.