title: [Adherence to international guidelines on early management in severe sepsis and septic shock].
abstract: BACKGROUND
  Complete adherence to early goal-directed therapy has shown a significant reduction in 28-day mortality rate, whereas partial adherence has not shown beneficial effect.
  
  
  OBJECTIVE
  The effect of adherence to 6 hour sepsis bundle treatment was evaluated on patients with severe sepsis and septic shock.
  
  
  METHODS
  A prospective cohort study was conducted during a six-month period. The patients were limited to those 16 years or older and included admissions to intensive care units, special care units or emergency departments with severe sepsis or septic shock. The adherence to the 6-hour sepsis bundle was evaluated through 8 interventions as follows: (1) serum lactate measure,( 2) early antibiotic administration, (3) blood culture samples, (4) infusion of intravenous fluids, (5) vasopressor use, (6) central venous catheter, (7) central venous pressure >8 mm Hg, and (8) central venous oxygen saturation >70%.
  
  
  RESULTS
  Seven hundred and twenty three patients were screened; 16% (n=116) met the inclusion criteria; 92.2% (n=107) met the criteria for severe sepsis and 37.9% (44) for septic shock; 62.9% (n=73) were subdiagnosed. Complete adherence to the 8 interventions of 6-hour sepsis bundle was 0%; 6 to 7 (19%, n=22), 3 to 5 (67.2%, n=78), and 0 to 2 (98.3%, n=114).
  
  
  CONCLUSIONS
  Adherence to 6-hour sepsis bundle treatment for severe sepsis and septic shock was not done for the full 8 interventions and only partial accomplishment of the first 4 interventions.
authors.affiliation: Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Universitario San Vicente de Paúl, Medellin, Colombia. rquinterof@gmail.com
authors.forename: Ricardo Andrés
authors.initials: RA
authors.lastname: Quintero
authors.forename: Carlos Arturo
authors.initials: CA
authors.lastname: Martínez
authors.forename: Juan Diego
authors.initials: JD
authors.lastname: Gamba
authors.forename: Isadora
authors.initials: I
authors.lastname: Ortiz
authors.forename: Fabián
authors.initials: F
authors.lastname: Jaimes
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001794:Blood Pressure; D002405:Catheterization, Central Venous; D003105:Colombia; D003131:Combined Modality Therapy; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005440:Fluid Therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006757:Hospital Units / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy / Q000628:therapy; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D007773:Lactates; D014662:Vasoconstrictor Agents; D010100:Oxygen