Adherence to international guidelines on early management in severe sepsis and septic shock
Abstract
Introduction. Complete adherence to early goal-directed therapy has shown a significant reduction in28-day mortality rate, whereas partial adherence has not shown beneficial effect.
Objectives. The effect of adherence to 6 hour sepsis bundle treatment was evaluated on patients withsevere sepsis and septic shock.
Materials and methods. A prospective cohort study was conducted during a six-month period. Thepatients were limited to those 16 years or older and included admissions to intensive care units, specialcare units or emergency departments with severe sepsis or septic shock. The adherence to the 6-hoursepsis bundle was evaluated through 8 interventions as follows: (1) serum lactate measure,( 2) earlyantibiotic administration, (3) blood culture samples, (4) infusion of intravenous fluids, (5) vasopressoruse, (6) central venous catheter, (7) central venous pressure >8 mm Hg, and (8) central venous oxygensaturation >70%.
Results. Seven hundred and twenty three patients were screened; 16% (n=116) met the inclusioncriteria; 92.2% (n=107) met the criteria for severe sepsis and 37.9% (44) for septic shock; 62.9% (n=73)were subdiagnosed. Complete adherence to the 8 interventions of 6-hour sepsis bundle was 0%; 6 to7 (19%, n=22), 3 to 5 (67.2%, n=78), and 0 to 2 (98.3%, n=114).
Conclusion. Adherence to 6-hour sepsis bundle treatment for severe sepsis and septic shock was notdone for the full 8 interventions and only partial accomplishment of the first 4 interventions.
doi: http://dx.doi.org/10.7705/biomedica.v32i3.349
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References
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