Effects of increasing compliance with medical care bundles on prognosis in patients with septic shock

Abstract

Objective To investigate the compliance with medical care bundles in patients with septic shock and effects of increasing compliance on prognosis.Method From January 2007 to June 2008,a prospective observational study of consecutive patients with septic shock admitted into ICU was carried out.The study was divided into pre-training stage(from January 2007 to September 2007)and post-training stage(from October 2007 to June 2008).The rate of compliance with medical care bundles for sepsis,the duration of mechanical ventilation,the duration of ICU stay and 28-day mortauty in two stages were documented.The percentages for categorical variables and mean±SD for continuous variables were expressed.Chi-square test and unpaired t-test were used for comparisons of groups,and statistical significance defined as P＜0.05.Results One hundred patients met the criteria of septic shock including 51 patients in pre-training stage and 49 patients in post-training stage were enrolled in the study.Compared with the post-training stage,the rates of compliance with 6-hour care bundle for sepsis in pretraining stage were expressed respectively by early goal-directed resuscitation(EGDT,19.6%vs.55.1%),HCT(hematocrit,64.7%vs.91.8%),plateau pressure(88.2%vs.95.9%),corticosteroid therapy(41.2%vs.62.3%),cardiotonic medication(41.2%vs.65.3%)and blood glucose control(45.1%vs.79.6%).At the same time,the rates of compliance with the 24-hour care bundle in pre-training stage in comparison with posttraining stage were respectively expressed in EGDT(35.3%vs.65.3%),HCT(35.3%vs.73.5%),plateau pressure(86.3%vs.97.9%),corticosteroid therapy(31.4%vs.69.4%),administration of positive inotropic medicine(52.9%vs.67.3%)and glucose control(47.1%vs.83.7%).Patients in post-training stage had the shorter duration of mechanical ventilation(P＜0.05),shorter stay in ICU(P＜0.01)and a lower 28-day mortauty rate(55.1%vs.76.5%,P＜0.05)than patients in pre-training stage.There were no significant differences in plateau pressure and cardiotonic medication between two stages.Conclusions The compliance with medical care bundles in patients with septic shock is poor.After training,physician can increase the compliance with medical care bundles for sepsis and improve prognosis. Key words: Septis shock; Sepsis bundles; Compliance; prognosis; Intensive care unit; Early goal-directed resuscitation; Training; Clinical study