title: Reducing mortality in severe sepsis with the implementation of a core 6-hour bundle: results from the Portuguese community-acquired sepsis study (SACiUCI study).
abstract: BACKGROUND
  To evaluate the impact of compliance with a core version of the Surviving Sepsis Campaign 6-hour bundle on 28 days mortality.
  
  
  METHODS
  Cohort, multi-centre, prospective study on community-acquired sepsis (CAS).
  
  
  RESULTS
  Seventeen intensive care units (ICU) entered the study. Over a one year period, 4,142 patients were enrolled in the study. Of the 897 (24%) admitted with CAS, 778 (87%) had severe sepsis or septic shock on ICU admission. In the first six hours of hospital admission: (1) 62% had serum lactate measured; (2) 69% fluids administered; (3) 77% specimens collected for microbiology before antibiotic administration; (4) 48% blood cultures obtained; (5) 52% antibiotics administered within the first hour of the diagnosis; (6) vasopressors were given in 78%; (7) 56% had central venous measurement (CVP) measurement; (8) 17% had a central venous oxygen saturation (ScvO2) measurement; (9) dobutamine was administered in 52%. Compliance with all actions 1 to 6 (core bundle) was associated with an odds ratio (OR) of 0.44 [95% confidence interval (CI) = 0.24-0.80] in severe sepsis and 0.49 (95% CI = 0.25-0.95) in septic shock, for 28 days mortality. This corresponded to a number needed to treat of 6 patients to save one life.
  
  
  CONCLUSIONS
  Compliance with this core bundle was associated with a significant reduction in the 28 days mortality. Urgent action should be taken in order to ensure that early sepsis diagnosis is followed by full completion of this "core bundle" followed by activation of expertise help in severe sepsis.
authors.affiliation: Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, University of Porto, Largo Prof, Abel Salazar, 4099-001 Porto, Portugal. cardoso.tmc@gmail.com
authors.forename: Teresa
authors.initials: T
authors.lastname: Cardoso
authors.forename: António Henriques
authors.initials: AH
authors.lastname: Carneiro
authors.forename: Orquídea
authors.initials: O
authors.lastname: Ribeiro
authors.forename: Armando
authors.initials: A
authors.lastname: Teixeira-Pinto
authors.forename: Altamiro
authors.initials: A
authors.lastname: Costa-Pereira
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000401:mortality*; D016001:Confidence Intervals; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011174:Portugal / Q000453:epidemiology; D011446:Prospective Studies; D018805:Sepsis / Q000401:mortality*; D012720:Severity of Illness Index; D013997:Time Factors
references.citation: N Engl J Med. 2005 Sep 29;353(13):1332-41
references.pmid: 16192478
references.citation: BMJ. 2000 Oct 14;321(7266):950-3
references.pmid: 11030691
references.citation: N Engl J Med. 2008 Jan 10;358(2):111-24
references.pmid: 18184957
references.citation: Am J Respir Crit Care Med. 2003 Jul 1;168(1):77-84
references.pmid: 12702548
references.citation: Crit Care Med. 1985 Oct;13(10):818-29
references.pmid: 3928249
references.citation: Crit Care. 2005;9(6):653-4
references.pmid: 16356261
references.citation: Crit Care. 2005;9(6):R764-70
references.pmid: 16356225
references.citation: Chest. 1992 Jun;101(6):1644-55
references.pmid: 1303622
references.citation: N Engl J Med. 2003 Apr 17;348(16):1546-54
references.pmid: 12700374
references.citation: Crit Care Med. 2004 Mar;32(3):858-73
references.pmid: 15090974
references.citation: Crit Care Med. 2009 Feb;37(2):410-6
references.pmid: 19114885
references.citation: JAMA. 1993 Dec 22-29;270(24):2957-63
references.pmid: 8254858
references.citation: Crit Care Med. 2006 Apr;34(4):1025-32
references.pmid: 16484890
references.citation: Crit Care Med. 2003 Apr;31(4):1250-6
references.pmid: 12682500
references.citation: J Clin Epidemiol. 2002 May;55(5):525-30
references.pmid: 12007557
references.citation: Am J Emerg Med. 2006 Sep;24(5):553-9
references.pmid: 16938593
references.citation: J Intern Med. 2004 Oct;256(4):316-23
references.pmid: 15367174
references.citation: Crit Care Med. 2004 Nov;32(11 Suppl):S595-7
references.pmid: 15542969
references.citation: Crit Care Med. 2007 Apr;35(4):1105-12
references.pmid: 17334251
references.citation: Med J Aust. 2004 Oct 18;181(8):428-31
references.pmid: 15487958
references.citation: N Engl J Med. 2009 Mar 26;360(13):1283-97
references.pmid: 19318384
references.citation: Chest. 2006 Nov;130(5):1579-95
references.pmid: 17099041
references.citation: JAMA. 2008 May 21;299(19):2294-303
references.pmid: 18492971
references.citation: Mayo Clin Proc. 2002 Jun;77(6):542-51
references.pmid: 12059124
references.citation: Crit Care Med. 2008 Jan;36(1):296-327
references.pmid: 18158437
references.citation: Intensive Care Med. 1996 Jul;22(7):707-10
references.pmid: 8844239
references.citation: Lancet. 1996 Sep 21;348(9030):771-5
references.pmid: 8813982
references.citation: Eur J Trauma Emerg Surg. 2008 Dec;34(6):561-9
references.pmid: 26816280