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Long-term effects of an in-hospital program on sepsis management in the ICU


A hospital program named Sopravvivere alla Sepsi nel Policlinico di Modena started in 2005 with the main objective to improve the survival rate of septic patients by means of continuous education and implementation of a sepsis operative protocol including the activation of a specific consultation by an intensivist and an infectious disease specialist. The aim of this study was to evaluate the long-term effects of this in-hospital program on compliance to treatments indicated by the evidence-based guidelines and on outcome in patients admitted to the ICU with septic shock (SS).


In patients admitted with SS to a 10-bed ICU from January 2005 to December 2009 we collected: age, type of admission (medical or surgical), site of infection, SAPS II, 30-day mortality and the application of five resuscitative (blood cultures before antibiotics, antibiotics within 3 hours, source control, adequate fluid resuscitation, SvO2 optimization within 6 hours) and four management interventions (glycemia control, steroid use, rhAPC administration and plateau inspiratory pressure <30 cmH2O) as suggested by the surviving sepsis guidelines. Patients with end-stage liver disease, age <18 years and indications for end-of-life treatment were excluded.


A total of 129 patients have been evaluated and the number of SS admissions increased from a mean value of 19 patients/year in the period 2005 to 2007 to a value of 36 patients/year in the past 2 years. Age, SAPS II and site of infection were similar throughout the analyzed period whereas the percentage of medical admission increased from 33% to 42% in the past 2 years. Compliance to the five resuscitative interventions improved progressively from 24% in 2005 to 63% in 2007. Subsequently, they came back to values observed at the starting of the project (21% in 2008 and 25% in 2009). Similarly, the adherence to management interventions increased quickly after 2005 (from 14% to 50% in 2006) but decreased to a mean value of 35% in the past 3 years. Immediately after 2005, the observed 30-day mortality rate became lower than that predicted by the SAPS II, but it slightly increased from 31% in 2006 to 48% in 2009.


The effects of an in-hospital program devoted to severe sepsis and SS management allowed an increase of ICU admissions for sepsis, a better management and an improvement of patients' survival rate. However, as expected, the adherence to guidelines gradually worsened with a slight increased in mortality rate in the past 2 years.

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Ferrari, E., Serafini, G., Trevisan, D. et al. Long-term effects of an in-hospital program on sepsis management in the ICU. Crit Care 15 (Suppl 1), P213 (2011).

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