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Abstract

with less mortality in patients receiving ≥3 vasopressors. Conclusions: Patients with a lactate ≥4 mmol/L or past medical history of congestive heart failure were found to be independent predictors of hospital mortality in patients receiving ≥3 vasopressors. Finally, antibiotics given within one hour of recognition was associated with lower mortality in patients receiving ≥3 vasopressors.Learning Objectives: The Surviving Sepsis Campaign (SSC) 2012 guidelines published updated bundles of care to guide healthcare providers in sepsis treatment. Updated bundle adherence and associated clinical outcomes have yet to be evaluated. Methods: This retrospective chart review included 110 patients who met ACCP/SCCM definition of sepsis, severe sepsis, or septic shock within the first six hours of emergency department admission. Patients were placed into predefined adherence tertiles based on percent bundle adherence (tertile 1: 0-33%, tertile 2: 34-66%, tertile 3: 67-100%). In-hospital mortality, resuscitation endpoints (e.g., lactate; mean arterial pressure; central venous pressure;central venous oxygen saturation), ICU length of stay (LOS), ventilator days, and Sequential Organ Failure Assessment (SOFA) scores were assessed at baseline, 24 hours, 72 hours, and discharge and compared between adherence tertiles. A multivariate logistic regression was performed in effort to identify predictors of mortality. Results: There was no difference in mortality seen between adherence groups in all patients (0%v 11.1% v. 6.7%, p=0.655) or those with severe sepsis or septic shock (0% v 13.3%v 0%, p=0.413). ICU length of stay and ventilator days was greater in patients in tertile 1 (3.1 v 0.4 v 0, p=0.039; 3.5 v 0 v 0, p=0.015). When morbidity endpoints were compared between patients admitted to the ICU and in those ventilated, no difference in ICU LOS or ventilator days was noted. No difference in ICU length of stay and ventilator days existed in patients in severe sepsis or septic shock. Median antibiotic administration time was 2.9 hours and 3.2 hours in all patients and patients with severe sepsis and septic shock, respectively. There was no difference in the amount of fluid given between groups. No predictors of mortality were identified. Conclusions: Adherence to 2012 SSC Bundles was relatively low. Bundle adherence did not improve clinical outcomes in emergency department patients with sepsis, severe sepsis, or septic shock.