title: Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study.
abstract: OBJECTIVE
  To assess the compliance of Asian intensive care units and hospitals to the Surviving Sepsis Campaign's resuscitation and management bundles. Secondary objectives were to evaluate the impact of compliance on mortality and the organisational characteristics of hospitals that were associated with higher compliance.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  150 intensive care units in 16 Asian countries.
  
  
  METHODS
  1285 adult patients with severe sepsis admitted to these intensive care units in July 2009. The organisational characteristics of participating centres, the patients' baseline characteristics, the achievement of targets within the resuscitation and management bundles, and outcome data were recorded.
  
  
  METHODS
  Compliance with the Surviving Sepsis Campaign's resuscitation (six hours) and management (24 hours) bundles.
  
  
  RESULTS
  Hospital mortality was 44.5% (572/1285). Compliance rates for the resuscitation and management bundles were 7.6% (98/1285) and 3.5% (45/1285), respectively. On logistic regression analysis, compliance with the following bundle targets independently predicted decreased mortality: blood cultures (achieved in 803/1285; 62.5%, 95% confidence interval 59.8% to 65.1%), broad spectrum antibiotics (achieved in 821/1285; 63.9%, 61.3% to 66.5%), and central venous pressure (achieved in 345/870; 39.7%, 36.4% to 42.9%). High income countries, university hospitals, intensive care units with an accredited fellowship programme, and surgical intensive care units were more likely to be compliant with the resuscitation bundle.
  
  
  CONCLUSIONS
  While mortality from severe sepsis is high, compliance with resuscitation and management bundles is generally poor in much of Asia. As the centres included in this study might not be fully representative, achievement rates reported might overestimate the true degree of compliance with recommended care and should be interpreted with caution. Achievement of targets for blood cultures, antibiotics, and central venous pressure was independently associated with improved survival.
authors.affiliation: Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System Tower Block, Level 10, 1E Kent Ridge Road, Singapore 119228.
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.forename: Yao-Qing
authors.initials: YQ
authors.lastname: Tang
authors.forename: Jigeeshu V
authors.initials: JV
authors.lastname: Divatia
authors.forename: Cheng Cheng
authors.initials: CC
authors.lastname: Tan
authors.forename: Charles D
authors.initials: CD
authors.lastname: Gomersall
authors.forename: Mohammad Omar
authors.initials: MO
authors.lastname: Faruq
authors.forename: Babu Raja
authors.initials: BR
authors.lastname: Shrestha
authors.forename: Nguyen
authors.initials: N
authors.lastname: Gia Binh
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
authors.forename: Nawal
authors.initials: N
authors.lastname: Salahuddin
authors.forename: Bambang
authors.initials: B
authors.lastname: Wahyuprajitno
authors.forename: Mei-Lien
authors.initials: ML
authors.lastname: Tu
authors.forename: Ahmad Yazid Haji Abd
authors.initials: AY
authors.lastname: Wahab
authors.forename: Akmal A
authors.initials: AA
authors.lastname: Hameed
authors.forename: Masaji
authors.initials: M
authors.lastname: Nishimura
authors.forename: Mark
authors.initials: M
authors.lastname: Procyshyn
authors.forename: Yiong Huak
authors.initials: YH
authors.lastname: Chan
mesh_terms: D001208:Asia; D006801:Humans; D007362:Intensive Care Units; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D018805:Sepsis / Q000628:therapy*; D012720:Severity of Illness Index