Abstract
IntroductionThe application in clinical practice of evidence-based guidelines for the management of patients with severe sepsis/septic shock is still poor in the emergency department, while little data are available for patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an in-hospital sepsis program on the adherence to evidence-based guidelines and outcome of patients with severe sepsis/septic shock admitted to the ICU.MethodsThis prospective observational cohort study included 67 patients with severe sepsis/septic shock admitted to a multidisciplinary ICU at a University Hospital from January 2005 to June 2007. Compliance to 5 resuscitation and 4 management sepsis interventions and in-hospital mortality were measured following an educational program on sepsis for physician and nurses of all hospital departments and hospital implementation of a specific protocol for recognition and management of patients with severe sepsis/septic shock, including an early consultation by a skilled 'sepsis team'.ResultsDuring the study period, the compliance to all 9 interventions increased from 8% to 35% of the patients (P < 0.01). The implementation of resuscitation and management interventions was associated with a lower risk of in-hospital mortality (23% vs 68% and 27% vs 68%, P < 0.01). In the latter 2 semesters, after activation of the 'sepsis team', in-hospital mortality of ICU septic shock patients decreased by about 40% compared with the previous period (32% vs 79%, P < 0.01).ConclusionsIn our experience, an in-hospital sepsis program, including education of health-care personnel and process-changes, improved the adherence to guidelines and the survival rate of patients with severe sepsis/septic shock admitted to the ICU.
Highlights
The application in clinical practice of evidencebased guidelines for the management of patients with severe sepsis/septic shock is still poor in the emergency department, while little data are available for patients admitted to the intensive care unit (ICU)
In our experience, an in-hospital sepsis program, including education of health-care personnel and processchanges, improved the adherence to guidelines and the survival rate of patients with severe sepsis/septic shock admitted to the ICU
We identified five resuscitation (6-hours bundle) and four management (24hours bundle) interventions: blood cultures collection before antibiotic administration; empiric antibiotic therapy within three hours from diagnosis; control of infection source within six hours; adequate fluid resuscitation before vasopressor administration; central venous oxygen saturation (ScvO2) above 70% within six hours; blood glucose median below 150 mg/dL in the first 24 hours; low-dose hydrocortisone administration in association with vasopressor support; recombinant human activated protein C if administration indicated; plateau inspiratory pressure below 30 cmH2O in patients with acute lung injury (ALI)/adult respiratory distress syndrome (ARDS)
Summary
The application in clinical practice of evidencebased guidelines for the management of patients with severe sepsis/septic shock is still poor in the emergency department, while little data are available for patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an in-hospital sepsis program on the adherence to evidence-based guidelines and outcome of patients with severe sepsis/septic shock admitted to the ICU. The main purpose of our study was to evaluate the effects of a 'surviving sepsis' in-hospital project, including specific educational program and operative protocols, on the adherence to evidence-based guidelines. We sought to assess if such a project could improve the outcome of patients with severe sepsis/septic shock admitted to an intensive care unit (ICU)
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