[The impact of sepsis bundles on mortality in patients with sepsis shock: a prospective clinical study].
OBJECTIVE
To survey the impact of sepsis bundle on prognosis of septic shock.


METHODS
From January 2007 to June 2008, a prospective clinical study was conducted on consecutive adult patients with sepsis shock in intensive care unit (ICU). The study of sepsis bundle on septic shock was divided into before training (from January to September 2007) and trained phases (from October 2007 to June 2008), and the patients were divided into control group and death group. The relationship between sepsis bundle index and prognosis at 6 hours and 24 hours was analyzed with logistic regression analysis. The independent factors of death due to septic shock were looked for. The compliance of sepsis bundles, duration of mechanical ventilation (MV), ICU stay, and 28-day mortality were noted.


RESULTS
One hundred patients, including 51 patients before training and 49 patients after training were enrolled for study. Thirty-six patients survived and 64 patients died. All the patients met the criteria for the diagnosis of sepsis shock. Through analysis of the parameters with logistic regression, it could be found that 6-hour early goal-directed therapy (EGDT) and 24-hour EGDT were the two independent protective factors of death, and standardized regression coefficient was 0.046 and 0.120 respectively (both P < 0.01). Compliance with sepsis bundles was low in training phase, the compliance increased apparently after training. Among them, 6-hour EGDT and 24-hour EGDT compliance increased to 55.1%, 65.3% from 19.6%, 35.3% (both P < 0.01). Compared with the group before training, the duration of MV [(166.6+/-156.4) hours vs. (113.6+/-73.6) hours], that of ICU stay [(9.4+/-7.6) days vs. (6.0+/-3.9) days] and 28-day mortality (72.5% vs. 55.1%, P < 0.05 or P < 0.01) was significantly lower after training.


CONCLUSIONS
Sepsis bundle is able to improve survival rate in patients in septic shock. Compliance with sepsis bundles is low before training, and training can improve the compliance and decrease mortality rate of septic shock.
Chen
Qi-hong
QH
Department of Criticial Care Medicine, Subei Hospital of Jiangsu Provience, Clinical Medical College, Yangzhou University, Yangzhou 225001, Jiangsu, China. chenqihong00@163.com
Zheng
Rui-qiang
RQ
Lin
Hua
H
Wang
Hua-ling
HL
Lu
Nian-fang
NF
Shao
Jun
J
Yu
Jiang-quan
JQ
D000368:Aged; D002985:Clinical Protocols; D003422:Critical Care / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis