title: Effectiveness of sepsis bundle application in cirrhotic patients with septic shock: a single-center experience.
abstract: OBJECTIVE
  To evaluate the effect of adherence to evidence-based guidelines of the Surviving Sepsis Campaign (SSC) on the outcome of cirrhotic patients with septic shock admitted to the intensive care unit.
  
  
  METHODS
  This prospective observational cohort study included 38 patients with documented liver cirrhosis and septic shock admitted to a multidisciplinary intensive care unit at a University Hospital from January 2005 to June 2009. In each patient, the compliance to 4 resuscitation (ie, 6-hour bundle) and to 3 management (i.e. 24-hour bundle) interventions recommended by the SSC guidelines and the 30-day mortality were measured.
  
  
  RESULTS
  The 6-hour, 24-hour, and all bundles were completed in 50 %, 52%, and 39% of the patients, respectively. The characteristics at admission and the 30-day mortality of patients with all-bundle compliance (n = 15; mortality 86.6%) were similar to those of patients without bundle compliance (n = 23; mortality 78.2%), except for central venous O2 saturation. Unadjusted and adjusted regression analysis showed that none of the single sepsis interventions and bundles were independently associated with 30-day mortality.
  
  
  CONCLUSIONS
  In our observational study, the adherence to the interventions recommended by the SSC evidence-based guidelines did not provide an improvement in the survival rate of cirrhotic patients with septic shock.
authors.affiliation: Department of Anaesthesiology and Intensive Care, University of Modena and Reggio Emilia and University Hospital of Modena, L.go del Pozzo, Modena, 41100, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Rinaldi
authors.forename: Elena
authors.initials: E
authors.lastname: Ferrari
authors.forename: Marco
authors.initials: M
authors.lastname: Marietta
authors.forename: Lara
authors.initials: L
authors.lastname: Donno
authors.forename: Davide
authors.initials: D
authors.lastname: Trevisan
authors.forename: Mauro
authors.initials: M
authors.lastname: Codeluppi
authors.forename: Stefano
authors.initials: S
authors.lastname: Busani
authors.forename: Massimo
authors.initials: M
authors.lastname: Girardis
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012772:Shock, Septic / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*