Reduction of the severe sepsis or septic shock associated mortality by reinforcement of the recommendations bundle: a multicenter study.
BACKGROUND
We determined whether the implementation of a bundle of 10 recommendations leads to the reduction of mortality in ICU patients with severe sepsis or septic shock.


METHODS
All patients with severe sepsis or septic shock during two consecutive phases: a 6-month quality control period (observational) and secondly a 6-month intervention period based on the implementation of a bundle of 10 recommendations adapted from the Surviving Sepsis Campaign guidelines (initial bacteriological samples and initiating antibiotics, measurement of arterial lactate, volume expansion > or =20 ml/kg, targeted mean arterial pressure > or =65 mmHg and the assessments of central venous pressure and Scv(O2); glucose control, low doses of corticosteroids, a tidal volume < or =8 ml/kg in mechanically ventilated patients with ALI; adequate use of recombinant human activated protein C) were evaluated in 15 ICUs. The primary endpoint was the 28-day mortality rate and the secondary endpoint was the compliance with the recommendations of the care bundle.


RESULTS
Four hundred and forty-five patients (230 and 215 in the observational and intervention periods, respectively) were included. In the two periods, the patients had similar characteristics. The 28-day mortality rate significantly decreased from 40% in the observational period to 27% in the intervention period (P=0.02). According to each recommendation, compliance with the care bundle was achieved in 9 to 100% of patients.


CONCLUSIONS
The implementation of a care bundle adapted from the Surviving Sepsis Campaign guidelines decreases the 28-day mortality rate in patients with severe sepsis and/or septic shock.
Lefrant
J-Y
JY
Division d'anesthésie-réanimation douleur urgences, centre hospitalier universitaire de Nîmes, groupe hospitalo-universitaire Caremeau, place du Professeur-Robert-Debré, Nîmes cedex 9, France. jean.yves.lefrant@chu-nimes.fr
Muller
L
L
Raillard
A
A
Jung
B
B
Beaudroit
L
L
Favier
L
L
Masson
B
B
Dingemans
G
G
Thévenot
F
F
Selcer
D
D
Jonquet
O
O
Capdevila
X
X
Fabbro-Peray
P
P
Jaber
S
S
D000368:Aged; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality* / Q000517:prevention & control; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000401:mortality* / Q000517:prevention & control