Decreasing mortality in severe sepsis and septic shock patients by implementing a sepsis bundle in a hospital setting

Sandra Christina Pereira Lima Shiramizo, Alexandre R Marra, Marcelino S Durão, Ângela T Paes, Michael B Edmond, Oscar Fernando Pavão dos Santos, Sandra Christina Pereira Lima Shiramizo, Alexandre R Marra, Marcelino S Durão, Ângela T Paes, Michael B Edmond, Oscar Fernando Pavão dos Santos

Abstract

Background: The Surviving Sepsis Campaign (SSC) guidelines for the management of severe sepsis (SS) and septic shock (SSh) have been recommended to reduce morbidity and mortality.

Materials and methods: A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize SS and SSh shock patients' clinical outcomes were performed by applying sepsis bundles (6- and 24-hour) in May 2006. We compared bundle compliance and patient outcomes before (July 2005-April 2006) and after (May 2006-December 2009) implementation of the interventions.

Results: A total of 564 SS and SSh patients were identified. Prior to the intervention, compliance with the 6 hour-sepsis resuscitation bundle was only 6%. After the intervention, compliance was as follows: 8.2% from May to December 2006, 9.3% in 2007, 21.1% in 2008 and 13.7% in 2009. For the 24 hour-management bundle, baseline compliance was 15.0%. After the intervention, compliance was 15.1% from May to December 2006, 21.4% in 2007, 27.8% in 2008 and 44.4% in 2009. The in-hospital mortality was 54.0% from July 2005 to April 2006, 41.1% from May to December 2006, 39.3% in 2007, 41.4% in 2008 and 16.2% in 2009.

Conclusion: These results suggest reducing SS and SSh patient mortality is a complex process that involves multiple performance measures and interventions.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Proportion of patients with severe…
Figure 1. Proportion of patients with severe sepsis and septic shock who died and who had completed bundle measures during the study period.

References

    1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–1310.
    1. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–1377.
    1. Silva E, Pedro MA, Sogayar AC, Mohovic T, Silva CL, et al. Brazilian Sepsis Epidemiological Study (BASES study). Crit Care. 2004;8:R251–260.
    1. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32:858–873.
    1. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2004;30:536–555.
    1. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–1655.
    1. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327.
    1. Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, et al. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care. 2007;35:1105–1112.
    1. De Miguel-Yanes JM, Munoz-Gonzalez J, Andueza-Lillo JA, Moyano-Villaseca B, Gonzalez-Ramallo VJ, et al. Implementation of a bundle of actions to improve adherence to the Surviving Sepsis Campaign guidelines at the ED. Am J Emerg Med. 2009;27:668–674.
    1. Peake SL, Bailey M, Bellomo R, Cameron PA, Cross A, et al. Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study. Resuscitation. 2009;80:811–818.
    1. Becker JU, Theodosis C, Jacob ST, Wira CR, Groce NE. Surviving sepsis in low-income and middle-income countries: new directions for care and research. Lancet Infect Dis. 2009;9:577–582.
    1. Ferrer R, Artigas A, Levy MM, Blanco J, Gonzalez-Diaz G, et al. Improvement in process of care and outcome after a multicenter severe sepsis education program in Spain. JAMA. 2008;299:2294–2303.
    1. Castellanos-Ortega A, Suberviola B, Garcia-Astudillo LA, Holanda MS, Ortiz F, et al. Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study. Crit Care Med. 2010;38:1036–1043.
    1. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, et al. Results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38:367–374.
    1. Trzeciak S, Dellinger RP, Abate NL, Cowan RM, Stauss M, et al. Translating research to clinical practice - A 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department. Chest. 2006;129:225–232.
    1. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef M. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118:9–11.
    1. Zaragoza R, Artero A, Camarena JJ, Sancho S, Gonzalez R, et al. The influence of inadequate empirical antimicrobial treatment on patients with bloodstream infections in an intensive care unit. Clin Microbiol Infect. 2003;9:412–418.
    1. Kang CI, Kim SH, Kim HB, Park SW, Choe YJ, et al. Pseudomonas aeruginosa bacteremia: Risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clin Infect Dis. 2003;37:745–751.
    1. Marra AR, Cal RG, Silva CV, Caserta RA, Paes AT, et al. Successful prevention of ventilator-associated pneumonia in an intensive care setting. Am J Infect Control. 2009;37:619–625.
    1. Marra AR, Cal RG, Durão MS, Correa L, Guastelli LR, et al. Impact of a program to prevent central line-associated bloodstream infection in the zero tolerance era. Am J Infect Control. 2010;38:434–439.
    1. Durao MS, Marra AR, Moura DF, Almeida SM, Fernandes CJ, et al. Tight glucose control versus intermediate glucose control: a quasi-experimental study. Anaesth Intensive Care. 2010;38:1–7.
    1. Finfer S, Chittock DR, Su SY, Blair D, Foster D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med; 2009;360:1283–1297.

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