Outcome of septic shock in older adults after implementation of the sepsis "bundle".
OBJECTIVE
To evaluate the effect on 28-day mortality of implementation of a sepsis "bundle" protocol for the treatment of older adults with septic shock.


METHODS
Observational prospective study with a historical control group.


METHODS
Tertiary care center.


METHODS
Eighty-seven consecutive patients recruited between May 2004 and February 2007 matched to a historic group identified between March 2001 and April 2004.


METHODS
Implementation of a sepsis protocol for the management of septic shock.


RESULTS
Subjects who were treated according to the sepsis "bundle" had an absolute risk reduction in 28-day mortality of 16% (95% confidence interval (CI)=-31% to -2%). The treatment group received a larger volume of fluid in the first 6 hours of presentation (3,960 +/- 1,990 vs 2,490 +/- 1,020 mL; P<.001) and lower doses of vasopressors (maximum dosage of norepinephrine 0.51 microg/kg per min (range 0.12-1.7) vs 0.98 microg/kg per min (range 0.15-3.1) P=.009). A high prevalence of adrenal insufficiency (86%) was identified in the study population. There were no significant differences between the treatment and control groups in the surviving patients with respect to duration of mechanical ventilation (median 8.5 vs 12.0, respectively; P=.07) or intensive care unit length of stay (median 12 days vs 15 days; P=.08). According to Cox regression analysis, implementation of the sepsis bundle protocol was independently associated with better 28-day survival (hazard ratio=0.54, 95% CI=0.33-0.86; P=.01).


CONCLUSIONS
Older patients with septic shock had a better 28-day survival rate when treated with a comprehensive sepsis "bundle" protocol.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Western New York Respiratory Research Center, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 14215, USA. solh@buffalo.edu
Ali A
AA
El Solh
Morohunfolu E
ME
Akinnusi
Leith N
LN
Alsawalha
Lilibeth A
LA
Pineda
D018806:APACHE; D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D012772:Shock, Septic / Q000401:mortality* / Q000628:therapy*; D018709:Statistics, Nonparametric; D015996:Survival Rate