The Impact of Duration of Organ Dysfunction on the Outcome of Patients with Severe Sepsis and Septic Shock

Freitas, Flávio Geraldo Rezende; Salomão, Reinaldo; Tereran, N; Mazza, Bruno Franco; Assunção, Murillo Santucci César de; Jackiu, M; Fernandes, H.; Machado, Flávia Ribeiro

doi:10.1590/s1807-59322008000400012

Cited by 24 publications

(17 citation statements)

References 26 publications

(20 reference statements)

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“…Ou seja, quanto mais tempo demorar a diagnosticar a disfunção orgânica, maior a chance de piora no quadro clínico do paciente, podendo até levá-lo a morte 10 . Dessa maneira, percebemos a importância das equipes médicas e de enfermagem no reconhecimento dos sinais de disfunção orgânica.…”

Section: Resultsunclassified

Avaliação Do Conhecimento De Médicos E Equipe De Enfermagem Nas Ocorrências De Sepse.

Melech

Paganini²

2016

Rev. Med. UFPR

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RESUMOOBJETIVO: Avaliar o conhecimento dos profissionais de Enfermagem e Medicina na identificação das ocorrências de sepse com o objetivo de implantar ações para a redução de morbimortalidade de pacientes vitimados por essa síndrome. MÉTODOS: Trata-se de um estudo de campo com abordagem quantitativa realizado em uma unidade de urgência e emergência, em um hospital público na cidade de Curitiba-PR, no período de agosto até setembro de 2015, cuja amostra inicial era de 236 profissionais, sendo 65 médicos, 31 enfermeiros, 39 técnicos e 101 auxiliares de enfermagem. Para avaliar o conhecimento desses profissionais foi aplicado um instrumento com perguntas e análise de 5 estudos de casos sobre a identificação de sinais e sintomas de sepse. RESULTADO: 92 profissionais participaram do estudo, sendo entre eles 27 médicos, 24 enfermeiros, 10 técnicos de enfermagem e 31 auxiliares de enfermagem. A partir da análise de dados, verificou-se um conhecimento inadequado pelos profissionais, tanto no reconhecimento de sinais e sintomas relacionados a SIRS e a disfunção orgânica, como também na identificação dos quadros clínicos. Com relação a sequência de atendimento ao paciente séptico nas primeiras 6 horas, apenas 17,4% responderam corretamente, contudo, referente ao momento correto para coleta de culturas, 81,5% do total dos profissionais responderam corretamente. CONCLUSÕES: Visto que o conhecimento desses profissionais está diretamente ligado a identificação e tratamento precoce da síndrome séptica, acredita-se que a realização dessa pesquisa possa colaborar para implantação de ações que visem diminuir o índice de morbimortalidade por essa síndrome.Descritores: SIRS, Disfunção orgânica, Sepse, Tratamento Precoce ABSTRACT OBJECTIVE: To assess the knowledge of nursing and medical professionals in identifying sepsis occurrences in order to implement actions to patient morbidity and mortality reduction victimized by this syndrome. METHODS: This is a field study with a quantitative approach carried out in an emergency unit and emergency, in a public hospital in the city of Curitiba, PR, from August to September 2015, the original sample was 236 professionals, and 65 doctors, 31 nurses, 39 technicians and 101 nursing assistants. To assess the knowledge of these professionals an instrument with questions and analysis of five case studies on the identification of signs and symptoms of sepsis was applied. RESULTS: 92 professionals participated in the study, including 27 doctors, 24 nurses, 10 nursing technicians and 31 nursing assistants. From the data analysis, it was found inadequate knowledge by professionals, in recognition of the signs and symptoms related to SIRS and organ dysfunction, as well as the identification of clinical pictures. Regarding the sequence of care septic patients within 6 hours, only 17.4% answered correctly, however, regarding the right time to collect cultures, 81.5% of the professionals answered correctly. CONCLUSIONS: As the knowledge of these professionals is directly linked to early identification an...

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Section: Resultsunclassified

Avaliação Do Conhecimento De Médicos E Equipe De Enfermagem Nas Ocorrências De Sepse.

Melech

Paganini²

2016

Rev. Med. UFPR

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“…Another explanation is that we evaluated compliance at the time of sepsis diagnosis. In Brazil, the time between the onset of organ dysfunction and a proper sepsis diagnosis can be long (28). In this context, the compliance measure after diagnosis would not reflect the appropriateness of the treatment.…”

Section: Discussionmentioning

confidence: 99%

Late recognition and illness severity are determinants of early death in severe septic patients

Machado¹,

Salomão²,

Rigato³

et al. 2013

Clinics

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OBJECTIVE:To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction.METHODS:In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses.RESULTS:The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction.CONCLUSION:Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients.

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“…(7,8,(11)(12)(13)(14)(15)(16) At the second stage, even if there had not been a greater compliance to the bundles, mortality decreased considerably, showing that prognosis does not rely on compliance to the therapeutic bundles, but also on the earlier diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…(7)(8)(9)(10)(11)(12)(13)(14) In our hospital, as well as in other Brazilian institutions, notwithstanding adhesion to SSC, mortality rates continue to be unacceptably high. (15)(16)(17) Perhaps this was related to delay in diagnosis of sepsis. Failure to identify sepsis delays onset of adequate treatment, causes progress of multiple organ dysfunction and severely jeopardizes prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

“…Failure to identify sepsis delays onset of adequate treatment, causes progress of multiple organ dysfunction and severely jeopardizes prognosis of patients. (16) Therefore, ongoing search for detection of signs of SIRS and organ dysfunction during routine control of vital signs, might involve identification of patients at risk of sepsis. In this context we proposed a simple institutional procedure to facilitate identification of severe sepsis or septic shock in our hospital.…”

Section: Introductionmentioning

confidence: 99%

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Estratégia de detecção precoce e redução de mortalidade na sepse grave

Westphal¹,

Feijó²,

Andrade³

et al. 2009

Rev. bras. ter. intensiva

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Objective: To evaluate the impact of implementing an institutional policy for detection of severe sepsis and septic shock.Methods: Study before (stage I), after (stage II) with prospective data collection in a 195 bed public hospital.. Stage I: Patients with severe sepsis or septic shock were included consecutively over 15 months and treated according to the Surviving Sepsis Campaign guidelines. Stage II: In the 10 subsequent months, patients with severe sepsis or septic shock were enrolled based on an active search for signs suggesting infection (SSI) in hospitalized patients. The two stages were compared for demographic variables, time needed for recognition of at least two signs suggesting infection (SSIΔt), compliance to the bundles of 6 and 24 hours and mortality.Results: We identified 124 patients with severe sepsis or septic shock, 68 in stage I and 56 in stage II. The demographic variables were similar in both stages. The Δt-SSI was 34 ± 54 hours in stage I and 7 ± 8.4 hours in stage II (p <0.001). There was no difference in compliance to the bundles. In parallel there was significant reduction of mortality rates at 28 days (54.4% versus 30%, p <0.02) and hospital (67.6% versus 41%, p <0.003). Conclusion: The strategy used helped to identify early risk of sepsis and resulted in decreased mortality associated with severe sepsis and septic shock.

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The Impact of Duration of Organ Dysfunction on the Outcome of Patients with Severe Sepsis and Septic Shock

Cited by 24 publications

References 26 publications

Avaliação Do Conhecimento De Médicos E Equipe De Enfermagem Nas Ocorrências De Sepse.

Avaliação Do Conhecimento De Médicos E Equipe De Enfermagem Nas Ocorrências De Sepse.

Late recognition and illness severity are determinants of early death in severe septic patients

Estratégia de detecção precoce e redução de mortalidade na sepse grave

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