Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study

Levy, Mitchell M.; Rhodes, Andrew; Phillips, Gary; Townsend, Sean R.; Schorr, Christa; Beale, Richard; Osborn, Tiffany M.; Lemeshow, Stanley; Chiche, Jean‐Daniel; Artigas, Antonio; Dellinger, R. Phillip

doi:10.1007/s00134-014-3496-0

Cited by 364 publications

(389 citation statements)

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“…The largest study to date examined the relationship between compliance with the SSC bundles (based on the 2004 guidelines) and mortality. A total of 29,470 patients in 218 hospitals in the United States, Europe, and South America were examined over a 7.5-year period [21]. Lower mortality was observed in hospitals with higher compliance.…”

Section: We Recommend That Hospitals and Hospital Systems Have A Perfmentioning

confidence: 99%

“…Although little literature includes controlled data to support this volume of fluid, recent interventional studies have described this as usual practice in the early stages of resuscitation, and observational evidence supports the practice [20,21]. The average volume of fluid pre-randomization given in the PROCESS and ARISE trials was approximately 30 mL/kg, and approximately 2 L in the PROMISE trial [17][18][19].…”

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confidence: 99%

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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: We Recommend That Hospitals and Hospital Systems Have A Perfmentioning

confidence: 99%

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confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…The mortality for septic patients increases by 7 % by every hour that antibiotic administration is delayed [12]. Increasing compliance with the resuscitation bundle of the Surviving Sepsis Campaign has been shown to effectively reduce mortality in patients with septic shock [14].…”

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Survival After Emergency General Surgery: What can We Learn from Enhanced Recovery Programmes?

et al. 2016

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Enhanced recovery after surgery (ERAS) has been adopted by many centres and across whole healthcare systems. The results have shown significant reductions in length of stay and postoperative complications. However, there has been very little change in these factors and mortality in emergency surgery. Can we learn from principles of ERAS for emergency abdominal surgery?Over the last 15 years, there has been a quiet revolution in the delivery of elective surgical care. The main drivers of these improvements are a combination of improved surgical techniques (laparoscopic and robotic assisted) and evidence-based perioperative pathways, otherwise termed enhanced recovery after surgery (ERAS) [1]. The results have seen significant reductions in postoperative complications, length of stay (LOS) and an improvement in longterm survival after some cancer operations [2,3].

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“…Although the current concepts of early goal-directed therapy are still focused on macrohemodynamics the implementation of these endpoints has been associated with improved septic shock survival over the past few years [16], and compliance with the initial resuscitation elements has been recently associated with a 40 % reduction in the odds of in-hospital mortality [17]. Nevertheless, a meta-analysis of early goal-directed therapy for patients with septic shock including the ARISE, the Pro-CESS, and the ProMISe trials with a total of 4200 patients could not find benefit of therapeutic schedules based on the Surviving Sepsis Guidelines bundles when compared to what was valued as usual care [18].…”

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Focus on acute circulatory failure

Bakker

2016

Intensive Care Med

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A task force of the European Society of Intensive Care Medicine published the results of a consensus conference on the definition, diagnosis, monitoring, and treatment of circulatory failure [1]. Circulatory failure was defined as a life-threatening, generalized form of acute circulatory failure with inadequate oxygen utilization by the cells resulting in cellular dysfunction as a result of dysoxia, i.e., the loss of the physiological independence of oxygen delivery and oxygen consumption associated with increased lactate levels.However, the interpretation of increased lactate levels may not be as straightforward as suggested. In many cases lactate levels remain elevated after initial resuscitation. Ospina-Tascón et al. [2] showed that under these circumstances, the use of the venous-arterial CO 2 to arterial-venous O 2 content difference ratio as a surrogate of the respiratory quotient could reveal an increased lactate level as a result of persisting anaerobic metabolism. Increased lactate with an abnormal ratio (suggesting anaerobic metabolism) was associated with an excess mortality of almost 30 % compared to APACHE II expected mortality. Therefore, early resolution of tissue hypoperfusion and oxygen delivery-dependent oxygen consumption might prevent excess mortality. As shown by Gu et al. [3] in their meta-analysis of four studies, the use of early therapy aimed at decreasing lactate levels in patients with sepsis is associated with a significant improvement in mortality [risk ratio 0.65 (95 % CI 0.26-1.95)].Frequently abnormalities in skin perfusion are present in circulatory failure. Coudroy et al. [4] showed that skin mottling was present in 49 % of septic shock patients. Prolonged mottling (more than 6 h) was associated with a 40 % mortality. Similarly, Ait-Oufella et al. [5] showed that persistent abnormal capillary refill time (CRT) after initial resuscitation was related to mortality in septic shock patients. Although these data confirm similar studies in circulatory failure, the effect of using skin perfusion as a goal of therapy on outcome is not yet clear [6].Fluid resuscitation is an important intervention to improve tissue perfusion. In this regard the results of the FENICE study [7] on the use of fluid challenges in intensive care are remarkable. From this study in 2213 patients admitted to 311 ICUs in 46 countries, it was clear that the use of a fluid bolus was mainly aimed at restoring blood pressure. In the majority of cases, central venous pressure (CVP) was used to predict fluid responsiveness and monitor effectiveness. This is most likely based on the misconception of the original Starling experiments where CVP was the dependent variable on venous return and cardiac function instead of an independent variable of preload [8]. The goal of fluid resuscitation should not be an increase in CVP but rather an increase in stressed volume resulting in an increase in mean systemic filling pressure (MSFP) and a rise in the pressure for venous return (Pvr = MSFP − CVP) thus increasing cardiac ou...

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Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study

Cited by 364 publications

References 20 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Survival After Emergency General Surgery: What can We Learn from Enhanced Recovery Programmes?

Focus on acute circulatory failure

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