Compliance with a sepsis bundle and its effect on intensive care unit mortality in surgical septic shock patients.
BACKGROUND
The Surviving Sepsis Campaign was launched in 2002, aiming at a 25% reduction in mortality in sepsis during a 5-year period. We hypothesized that the compliance with an adapted sepsis bundle would improve intensive care unit (ICU) survival in a cohort of surgical septic shock patients.


METHODS
A retrospective, observational study was performed in surgical ICUs from two University hospitals. Seven quality indicators were considered to study the compliance with the sepsis bundle in 182 patients: (1) administration of antibiotics within 6 hours from diagnosis of septic shock, (2) initial effective antibiotic treatment, (3) adequate resuscitation within 6 hours after the diagnosis of septic shock, (4) administration of steroids, (5) use of activated protein C, (6) glucose control, and (7) protective ventilation. Univariate and multivariate logistic regression analyses were performed to make a predictive model to study the probability of survival according to the number of therapeutic guidelines fulfilled and to adjust for other predictive factors.


RESULTS
Compliance with individual guidelines was considered adequate in more than 60% of the cases, except in the case of glucose control. For all quality indicators, ICU survival was higher in the bundle-compliant patients. Survival (61%) was associated with the fulfilment of increasing number of therapeutic guidelines (odds ratio, 1.64; 95% confidence interval, 1.28-2.1; p < 0.001).


CONCLUSIONS
In surgical septic shock patients, the outcome was significantly related to the number of fulfilled therapeutic guidelines included in a sepsis bundle.
Pestaña
David
D
Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, Spain. dpestana.hulp@salud.madrid.org
Espinosa
Elena
E
Sangüesa-Molina
Julio R
JR
Ramos
Raquel
R
Pérez-Fernández
Elia
E
Duque
Marta
M
Martínez-Casanova
E
E
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012151:Resuscitation / Q000401:mortality*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013030:Spain / Q000453:epidemiology