Abstract
IntroductionCompliance with the ventilator care bundle affects the rate of ventilator-associated pneumonia. It was not known, however, whether compliance with sepsis care bundles has an impact on outcome. The aims of the present study were to determine the rate of compliance with 6-hour and 24-hour sepsis bundles and to determine the impact of the compliance on hospital mortality in patients with severe sepsis or septic shock.MethodsWe conducted a prospective observational study on 101 consecutive adult patients with severe sepsis or septic shock on medical or surgical wards, or in accident and emergency areas at two acute National Health Service Trust Teaching hospitals in England. The main outcome measures were: the rate of compliance with 6-hour and 24-hour sepsis care bundles adapted from the Surviving Sepsis Campaign guidelines on patients' clinical care; and the difference in hospital mortality between the compliant and the non-compliant groups.ResultsThe median age of the patients was 69 years (interquartile range 51 to 78), and 53% were male. The sources of infection were sought and confirmed in 87 of 101 patients. The chest was the most common source (50%), followed by the abdomen (22%). The rate of compliance with the 6-hour sepsis bundle was 52%. Compared with the compliant group, the non-compliant group had a more than twofold increase in hospital mortality (49% versus 23%, relative risk (RR) 2.12 (95% confidence interval (CI) 1.20 to 3.76), P = 0.01) despite similar age and severity of sepsis. Compliance with the 24-hour sepsis bundle was achieved in only 30% of eligible candidates (21/69). Hospital mortality was increased in the non-compliant group from 29% to 50%, with a 76% increase in risk for death, although the difference did not reach statistical significance (RR 1.76 (95% CI 0.84 to 3.64), P = 0.16).ConclusionNon-compliance with the 6-hour sepsis bundle was associated with a more than twofold increase in hospital mortality. Non-compliance with the 24-hour sepsis bundle resulted in a 76% increase in risk for hospital death. All medical staff should practise these relatively simple, easy and cheap bundles within a strict timeframe to improve survival rates in patients with severe sepsis and septic shock.
Highlights
Compliance with the ventilator care bundle affects the rate of ventilator-associated pneumonia
Hospital mortality was increased in the non-compliant group from 29% to 50%, with a 76% increase in risk for death, the difference did not reach statistical significance (RR 1.76, P = 0.16)
Six-hour basic ward care Within the first 6 hours following the diagnosis of severe sepsis, when patients had already developed one organ failure, we found that of the 101 patients, 8% had no oxygen administered, 14% had no iv access established, and 14% had no essential monitoring, including blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, urine output and level of consciousness described as Modified Early Warning Scores (MEWS)
Summary
Compliance with the ventilator care bundle affects the rate of ventilator-associated pneumonia It was not known, whether compliance with sepsis care bundles has an impact on outcome. The aims of the present study were to determine the rate of compliance with 6-hour and 24-hour sepsis bundles and to determine the impact of the compliance on hospital mortality in patients with severe sepsis or septic shock. Severe sepsis (infection-induced organ failure) usually develops as a consequence of infection in general medical and surgical wards, and is often initially managed by the nonintensive care medical team, the patient's usual destination is an intensive care unit (ICU). Severe sepsis is CI = confidence interval; ICU = intensive care unit; MEWS = Modified Early Warning Scores; NHS = National Health Service; NNT = number needed to treat; RR = relative risk; ScVO2 = central venous oxygen saturation; SSC = Surviving Sepsis Campaign. Severe sepsis is frequently fatal, mortality rates remaining between 30% to 50% [3], or 500,000 deaths per year worldwide, with as many deaths annually as those from acute myocardial infarction and the number is projected to grow at a rate of 1.5% per year [4]
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