Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study

Jason Phua, Younsuck Koh, Bin Du, Yao-Qing Tang, Jigeeshu V Divatia, Cheng Cheng Tan, Charles D Gomersall, Mohammad Omar Faruq, Babu Raja Shrestha, Nguyen Gia Binh, Yaseen M Arabi, Nawal Salahuddin, Bambang Wahyuprajitno, Mei-Lien Tu, Ahmad Yazid Haji Abd Wahab, Akmal A Hameed, Masaji Nishimura, Mark Procyshyn, Yiong Huak Chan, MOSAICS Study Group, Xiang-Yu Zhang, Bisharad M Shrestha, Abdul Diab, Meng-Chih Lin, Akmal A Hameed, Lutful Aziz, Kaniz Fatema, A K Qumrul Huda, Mohammad Faruk, Mohammad Omar Faruq, M H M Delwar Hossain, U H Shahera Khatun, M A Mannan, A S M Areef Ahsan, Rownak Jahan Tamanna, Md Sayedul Islam, Fatema Ahmed, Md Maniruzzaman, Ahmad Yazid Haji Abd Wahab, Chun-Liang Yan, Yu-Hong Mi, Yuan Xu, Li Yi, Zhi-Xiang Li, Xian-Yao Wan, Xue Wang, Song-Jing Shi, Shou-Hong Wang, Juan-Xian Gu, Ping Xu, Guo-Xie Zhang, Ying-Ying Hu, Zhi Chen, Xu-Dong Han, Bin Du, Yu-Hong Liu, Ying Duan, De-Chang Chen, Shao-Lin Ma, Kang-Long Yu, Xiao-Hua Song, Tong-Wa Cao, Jie Shen, Ping Qu, Xiang-Yu Zhang, Huai-Sheng Chen, Xiao-Bo Huang, Jian-Hong Fu, Jian-Guo Tang, Chuan-Yun Qian, Shi-Zhong Sun, Hong-Yang Xu, Dong-Hui Jiang, Shu-Yun Wang, Wen-Da Huang, Qi-Ming Liang, Ren-Hua Sun, Xiao-Min Lu, Jian-Guo Li, Du-Ming Zhu, Fu Loi Chow, Claudia Cheng, H P Shum, Charles Gomersall, Anne Leung, Karl Young, Subhash Todi, Ashwin Kumar Mani, Babu K Abraham, N Ramakrishnan, Deepak Govil, Srinivas Samavedam, Shoma V Rao, Sameer Jog, Shiva Kumar Iyer, B D Bande, Samir Sahu, Shyam Sunder Tipparaju, Somnath Chatterjee, Farhad Kapadia, Shilpa Kulkarni, C K Jani, M H Patel, Prakash Shastri, Sameer Saikia, Nayana Amin, Jigeeshu Divatia, Achsanuddin Hanafie, Rudy Manalu, Bambang Wahjuprajitno, Tommy Sunartomo, Syafri K Arif, I Wayan Suranadi, Rudyanto Sedono, Masaji Nishimura, Ahmad Shaltut Othman, Li Ling Tai, Mohd Ridhwan Mohd Noor, Anita Alias, Chew Har Lim, Cheng Cheng Tan, Shanthi Ratnam, AsNiza Abdul Shukor, Jenny May Geok Tong, Raha Abdul Rahman, Babu Raja Shrestha, Shyam Krishna Maharjan, Nawal Salahuddin, Zafar Ahmed, Asim Noor, Hasan Al-Dorzi, Yaseen M Arabi, Ali Al Azem, Ismael Qushmaq, Yasser Mandourah, Azman Johan, Naville Chia, Augustine Tee, Huae Min Tham, Dipika Agrawal, Addy Yong Hui Tan, Kenneth Ping-Wah Chan, Chai Rick Soh, Benjamin Choon-Heng Ho, Shi Loo, Young Joo Lee, Younsuck Koh, Suk Kyung Hong, Kyung Chan Kim, Myung Goo Lee, Jae Yeol Kim, Ki Man Lee, Gyu Rak Chon, Hee Sun Park, Soo Jung Um, Hye Sook Choi, Jin Hwa Lee, Ki Suck Jung, Tae Hyung Kim, Sung Soon Lee, Jae Hwa Cho, Kyoung Min Lee, Choon Hak Lim, Je Hyeong Kim, Jung Eun Choi, Yun Seong Kim, Seok Chan Kim, Shin Ok Koh, Moo Suk Park, Kwang Won Seo, Won Yeon Lee, Sei Hoon Sei Hoon, Wen Feng Fang, Kuo-Tung Huang, Gia Binh Nguyen, Xuan Co Dao, Dang Tuan Nguyen, Thi Ngoc Thao Pham, Thi Xuan Phan, Ngoc Hai Truong, Thanh Cang Tran, Jason Phua, Younsuck Koh, Bin Du, Yao-Qing Tang, Jigeeshu V Divatia, Cheng Cheng Tan, Charles D Gomersall, Mohammad Omar Faruq, Babu Raja Shrestha, Nguyen Gia Binh, Yaseen M Arabi, Nawal Salahuddin, Bambang Wahyuprajitno, Mei-Lien Tu, Ahmad Yazid Haji Abd Wahab, Akmal A Hameed, Masaji Nishimura, Mark Procyshyn, Yiong Huak Chan, MOSAICS Study Group, Xiang-Yu Zhang, Bisharad M Shrestha, Abdul Diab, Meng-Chih Lin, Akmal A Hameed, Lutful Aziz, Kaniz Fatema, A K Qumrul Huda, Mohammad Faruk, Mohammad Omar Faruq, M H M Delwar Hossain, U H Shahera Khatun, M A Mannan, A S M Areef Ahsan, Rownak Jahan Tamanna, Md Sayedul Islam, Fatema Ahmed, Md Maniruzzaman, Ahmad Yazid Haji Abd Wahab, Chun-Liang Yan, Yu-Hong Mi, Yuan Xu, Li Yi, Zhi-Xiang Li, Xian-Yao Wan, Xue Wang, Song-Jing Shi, Shou-Hong Wang, Juan-Xian Gu, Ping Xu, Guo-Xie Zhang, Ying-Ying Hu, Zhi Chen, Xu-Dong Han, Bin Du, Yu-Hong Liu, Ying Duan, De-Chang Chen, Shao-Lin Ma, Kang-Long Yu, Xiao-Hua Song, Tong-Wa Cao, Jie Shen, Ping Qu, Xiang-Yu Zhang, Huai-Sheng Chen, Xiao-Bo Huang, Jian-Hong Fu, Jian-Guo Tang, Chuan-Yun Qian, Shi-Zhong Sun, Hong-Yang Xu, Dong-Hui Jiang, Shu-Yun Wang, Wen-Da Huang, Qi-Ming Liang, Ren-Hua Sun, Xiao-Min Lu, Jian-Guo Li, Du-Ming Zhu, Fu Loi Chow, Claudia Cheng, H P Shum, Charles Gomersall, Anne Leung, Karl Young, Subhash Todi, Ashwin Kumar Mani, Babu K Abraham, N Ramakrishnan, Deepak Govil, Srinivas Samavedam, Shoma V Rao, Sameer Jog, Shiva Kumar Iyer, B D Bande, Samir Sahu, Shyam Sunder Tipparaju, Somnath Chatterjee, Farhad Kapadia, Shilpa Kulkarni, C K Jani, M H Patel, Prakash Shastri, Sameer Saikia, Nayana Amin, Jigeeshu Divatia, Achsanuddin Hanafie, Rudy Manalu, Bambang Wahjuprajitno, Tommy Sunartomo, Syafri K Arif, I Wayan Suranadi, Rudyanto Sedono, Masaji Nishimura, Ahmad Shaltut Othman, Li Ling Tai, Mohd Ridhwan Mohd Noor, Anita Alias, Chew Har Lim, Cheng Cheng Tan, Shanthi Ratnam, AsNiza Abdul Shukor, Jenny May Geok Tong, Raha Abdul Rahman, Babu Raja Shrestha, Shyam Krishna Maharjan, Nawal Salahuddin, Zafar Ahmed, Asim Noor, Hasan Al-Dorzi, Yaseen M Arabi, Ali Al Azem, Ismael Qushmaq, Yasser Mandourah, Azman Johan, Naville Chia, Augustine Tee, Huae Min Tham, Dipika Agrawal, Addy Yong Hui Tan, Kenneth Ping-Wah Chan, Chai Rick Soh, Benjamin Choon-Heng Ho, Shi Loo, Young Joo Lee, Younsuck Koh, Suk Kyung Hong, Kyung Chan Kim, Myung Goo Lee, Jae Yeol Kim, Ki Man Lee, Gyu Rak Chon, Hee Sun Park, Soo Jung Um, Hye Sook Choi, Jin Hwa Lee, Ki Suck Jung, Tae Hyung Kim, Sung Soon Lee, Jae Hwa Cho, Kyoung Min Lee, Choon Hak Lim, Je Hyeong Kim, Jung Eun Choi, Yun Seong Kim, Seok Chan Kim, Shin Ok Koh, Moo Suk Park, Kwang Won Seo, Won Yeon Lee, Sei Hoon Sei Hoon, Wen Feng Fang, Kuo-Tung Huang, Gia Binh Nguyen, Xuan Co Dao, Dang Tuan Nguyen, Thi Ngoc Thao Pham, Thi Xuan Phan, Ngoc Hai Truong, Thanh Cang Tran

Abstract

Objectives: To assess the compliance of Asian intensive care units and hospitals to the Surviving Sepsis Campaign's resuscitation and management bundles. Secondary objectives were to evaluate the impact of compliance on mortality and the organisational characteristics of hospitals that were associated with higher compliance.

Design: Prospective cohort study.

Setting: 150 intensive care units in 16 Asian countries.

Participants: 1285 adult patients with severe sepsis admitted to these intensive care units in July 2009. The organisational characteristics of participating centres, the patients' baseline characteristics, the achievement of targets within the resuscitation and management bundles, and outcome data were recorded.

Main outcome measure: Compliance with the Surviving Sepsis Campaign's resuscitation (six hours) and management (24 hours) bundles.

Results: Hospital mortality was 44.5% (572/1285). Compliance rates for the resuscitation and management bundles were 7.6% (98/1285) and 3.5% (45/1285), respectively. On logistic regression analysis, compliance with the following bundle targets independently predicted decreased mortality: blood cultures (achieved in 803/1285; 62.5%, 95% confidence interval 59.8% to 65.1%), broad spectrum antibiotics (achieved in 821/1285; 63.9%, 61.3% to 66.5%), and central venous pressure (achieved in 345/870; 39.7%, 36.4% to 42.9%). High income countries, university hospitals, intensive care units with an accredited fellowship programme, and surgical intensive care units were more likely to be compliant with the resuscitation bundle.

Conclusions: While mortality from severe sepsis is high, compliance with resuscitation and management bundles is generally poor in much of Asia. As the centres included in this study might not be fully representative, achievement rates reported might overestimate the true degree of compliance with recommended care and should be interpreted with caution. Achievement of targets for blood cultures, antibiotics, and central venous pressure was independently associated with improved survival.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: JP, YK, BD, JVD, CCT, BW, M-LT, and MN are directors of the Asia Ventilation Forum and have received travel support for the Asia Ventilation Forum Board of Directors meeting as well as honorariums for lectures in the Asia Ventilation Forum Annual Scientific Meeting from Covidien; MP is an employee of Covidien but contributes to the work in his own personal capacity.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787988/bin/phuj839456.f1_default.jpg
Fig 1 Compliance with resuscitation and management bundles by country. Only countries that enrolled more than 100 patients are shown. Others include Bahrain, Bangladesh, Brunei, Indonesia, Japan, Nepal, Pakistan, Saudi Arabia, Taiwan, and Vietnam. Drotrecogin alfa was unavailable in nine countries, including China, Hong Kong, and South Korea
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787988/bin/phuj839456.f2_default.jpg
Fig 2 Proportion of emergency departments and intensive care units with facilities and equipment to perform various functions. Emergency departments not surveyed for drotrecogin alfa and glucose measurements. Fibreoptic catheters with in vivo spectrophotometry or blood gas analysers with co-oximetry are required to measure ScvO2 and SvO2. CVP=central venous pressure; ScvO2=central venous oxygen saturation; SvO2=mixed venous oxygen saturation
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787988/bin/phuj839456.f3_default.jpg
Fig 3 Proportion of emergency departments and intensive care units with protocols to achieve individual bundle targets. Emergency departments not surveyed for steroids, drotrecogin alfa, glucose measurements, and tidal volumes. CVP=central venous pressure; PBW=predicted body weight; ScvO2=central venous oxygen saturation; SvO2=mixed venous oxygen saturation
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787988/bin/phuj839456.f4_default.jpg
Fig 4 Achievement of specific bundle targets in intensive care units with and without corresponding protocols. CVP=central venous pressure; PBW=predicted body weight; ScvO2=central venous oxygen saturation; SvO2=mixed venous oxygen saturation

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Source: PubMed

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