Reduced mortality after the implementation of a protocol for the early detection of severe sepsis

Westphal, Glauco Adrieno; Köenig, Álvaro; Filho, Milton Caldeira; Feijó, Janaína; Oliveira, Louise Trindade de; Nunes, Fernanda Bordignon; Fujiwara, Kênia; Martins, Sheila Fonseca; Gonçalves, Anderson Ricardo Roman

doi:10.1016/j.jcrc.2010.08.001

Cited by 58 publications

(58 citation statements)

References 28 publications

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“…As detection of the syndrome was low during usual clinical care, it is unsurprising, that the Sepsis 6 bundle has only been applied in ad-hoc manner [3]. It has been shown previously that improving the detection, raising awareness of the problem and concentrated efforts to improve basic sepsis care can lead to significant mortality reduction, even if bundle compliance remains low [18]. Possibly due to the low sample size, we could not show any mortality benefit from use of the full Sepsis 6 bundle, or any individual elements applied.…”

Section: Discussionmentioning

confidence: 99%

Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

et al. 2016

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Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis). There were 5317 in-patients in the 24-hour study period. Data were returned on 1198 digital data collection forms on patients with NEWS≥3 of which 87 were removed, leaving 1111 for analysis. 146 patients had sepsis and 144 patients had severe sepsis. Combined prevalence of sepsis and severe sepsis was 5.5% amongst all in-patients. Patients with sepsis had significantly higher NEWS scores (3 IQR 3–4 for non-sepsis and 4 IQR 3–6 for sepsis patients, respectively). Common organ dysfunctions in severe sepsis were hypoxia (47%), hypoperfusion (40%) and acute kidney injury (25%). Mortality at 90 days was 31% with a median (IQR) hospital free stay of 78 (36–85) days. Screening for sepsis, referral to Critical Care and completion of Sepsis 6 bundle was low: 26%, 16% and 12% in the sepsis group. Multivariable logistic regression analysis identified higher National Early Warning Score, diabetes, COPD, heart failure, malignancy and current or previous smoking habits as independent variables suggesting the diagnosis of sepsis. We observed that sepsis is more prevalent in the general ward and ED than previously suggested before and that screening and effective treatment for sepsis and severe sepsis is far from being operationalized in this environment, leading to high 90 days mortality.

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Section: Discussionmentioning

confidence: 99%

Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

et al. 2016

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“…As the experience with the use of sepsis protocols increases in course of time, the mortality is expected to decrease in each year, and in our center, sepsis-related mortality decreased from 26% in 2006 to 18% in the present study [3,[5][6][7][8]10]. Despite the application of sepsis protocols, mortality rate is still high in septic ICU patients, particularly in the septic shock and multi-organ failure patients [16,24,25].…”

Section: Discussionmentioning

confidence: 85%

“…Diagnosis of severe sepsis and implication of sepsis protocols since 2006 led to promising results in reduction of mortality of patients with severe sepsis/septic shock [7,8]. Therefore, current research focused on determining modifiable factors associated with sepsis mortality in addition to the well-known parameters.…”

Section: Introductionmentioning

confidence: 99%

Does Total Parenteral Nutrition Increase the Mortality of Patients with Severe Sepsis in the ICU?

et al. 2015

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OBJECTIVES:We aimed to evaluate the independent association between total parenteral nutrition (TPN) and nosocomial infection and intensive care unit (ICU) mortality in patients with severe pulmonary sepsis. MATERIAL AND METHODS:The present study was designed as a retrospective observational cohort study. We enrolled all patients with severe sepsis due to pulmonary infections who stayed more than 24 h in the respiratory ICU between January 2009 and December 2010. We recorded demographic characteristics, ICU severity scores, Acute Physiologic and Chronic Health Evaluation II (APACHE II) and first day Sequential Organ Failure Assessment (SOFA) score in the ICU, TPN because of intolerance to enteral feeding, ICU data, and mortality. To evaluate the risk factors for mortality, we performed adjusted logistic regression test for TPN, nosocomial infection, and SOFA in the model. RESULTS:Five hundred and fifty patients (males=375, females=175) with severe sepsis were involved in the study during the study period. The median and interquartile range (IQR) of age, APACHE II, and SOFA score at the time of admission to the ICU were 65 years (53-73), 20 (16-25), and 4 (3-6), respectively. Mortality rate was 18% (n=99). Adjusted odds ratio (OR), confidence intervals (CI) 95%, and p values of TPN, nosocomial infection, and first day SOFA score for mortality were as follows: OR:3.8, CI:2.3-6.1, p<0.001; OR:2.4, CI: 1.4-3.9, p<0.001; and OR: 1.3, CI:1.2-1.4, p<0.001, respectively. CONCLUSION:Nosocomial infection and the need for TPN because of intolerance of enteral nutrition (EN) is associated with a higher mortality rate in patients with severe sepsis in the ICU. Rational use of antibiotics and application of hospital acquired infection control program will further reduce mortality. KEYWORDS:

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“…(19) Although in severe sepsis, the main factor that influences mortality is early antibiotic treatment, many other therapeutic measures seem to influence a non-measurable variable that might be defining for the outcomes: greater attention paid to patients. (20) Thus, the analogy between goal-managed care in sepsis and deceased potential donors seems quite appropriate.…”

Section: Discussionmentioning

confidence: 99%

Protocolo gerenciado de tratamento do potencial doador falecido reduz incidência de parada cardíaca antes do explante dos órgãos

Westphal¹,

Zaclikevis²,

Vieira³

et al. 2012

Rev. bras. ter. intensiva

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ObjectiveTo assess the effect of the application of a managed protocol for the maintenance care of deceased potential multiple organ donors at two hospitals. MethodsA before (Phase 1)/after (Phase 2) study conducted at two general hospitals, which included consecutively potential donors admitted to two intensive care units. In Phase 1 (16 months), the data were collected retrospectively, and the maintenance care measures of the potential donors were instituted by the intensivists. In Phase 2 (12 months), the data collection was prospective, and a managed protocol was used for maintenance care. The two phases were compared in terms of their demographic variables, physiological variables at diagnosis of brain death and the end of the process, time to performance of brain death confirmatory test and end of the process, adherence to bundles of maintenance care essential measures, losses due to cardiac arrest, family refusal, contraindications, and the conversion rate of potential into actual donors. Student's t- and chi-square tests were used, and p-value < 0.05 was considered to be significant. ResultsA total of 42 potential donors were identified (18 in Phase 1 and 24 in Phase 2). The time interval between the first clinical assessment and the recovery decreased in Phase 2 (Phase 1: 35.0±15.5 hours versus Phase 2: 24.6±6.2 hours; p = 0.023). Adherence increased to 10 out of the 19 essential items of maintenance care, and losses due to cardiac arrest also decreased in Phase 2 (Phase 1: 27.8 versus 0% in Phase 2; p = 0.006), while the convertion rate increased (Phase 1: 44.4 versus 75% in Phase 2; p = 0.044). The losses due to family refusal and medical contraindication did not vary. ConclusionThe adoption of a managed protocol focused on the application of essential measures for the care of potential deceased donors might reduce the loss of potential donors due to cardiac arrest.

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Reduced mortality after the implementation of a protocol for the early detection of severe sepsis

Cited by 58 publications

References 28 publications

Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

Does Total Parenteral Nutrition Increase the Mortality of Patients with Severe Sepsis in the ICU?

Protocolo gerenciado de tratamento do potencial doador falecido reduz incidência de parada cardíaca antes do explante dos órgãos

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