The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis

Abstract

ObjectiveThe Surviving Sepsis Campaign (SSC or “the Campaign”) developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes.Design and settingA multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were “bundled” into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008.Main resultsData from 15,022 subjects at 165 sites were analyzed to determine the compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 years (P < 0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years (P = 0.008). Compliance with all bundle elements increased significantly, except for inspiratory plateau pressure, which was high at baseline. Unadjusted hospital mortality decreased from 37 to 30.8% over 2 years (P = 0.001). The adjusted odds ratio for mortality improved the longer a site was in the Campaign, resulting in an adjusted absolute drop of 0.8% per quarter and 5.4% over 2 years (95% CI, 2.5–8.4%).ConclusionsThe Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-009-1738-3) contains supplementary material, which is available to authorized users.

Prognostic Value of Plateau Pressure Below 30 cm H2O in Septic Subjects With Acute Respiratory Failure

“…32 In this study, the rate of achieved resuscitation goals was Ͼ 50% that in a large international survey. 15 The rates of resuscitation goals achieved were not different between survivors and nonsurvivors. Moreover, the mean values of central venous oxygen saturation in both groups were high, fulfilling the criteria of the Surviving Sepsis Campaign.…”

“…The mean values of central venous oxygen saturation in both survivor and nonsurvivor groups were higher than the criteria desired according to the Surviving Sepsis Campaign. 15 The subjects were then divided into ARDS and non-ARDS groups according to baseline oxygenation status to evaluate the power of outcome prediction of P plat . In the ARDS group (baseline P aO 2 /F IO 2 Ͻ 300, n ϭ 191), nonsurvivors had significantly higher P plat levels than survivors (Fig.…”

Can we find accessible and relevant markers for sepsis outcome?

“…(2,3,(8)(9)(10) A recent study showed that SIRS criteria failed to identify 1 of 8 patients with severe sepsis, that 2 SIRS criteria do not represent a cut-off for risk and that the risk of death is increasing linearly with each additional SIRS criteria. (11) We did not find any correlation between the number of SIRS criteria and sepsis severity based on mortality.…”

Initial resuscitation from severe sepsis: one size does not fit all

“…Finally the SSC leadership concluded: "The strong recommendation for achieving a CVP of 8 to 12 mm Hg and an S cv O 2 of 70% in the first 6 hours of resuscitation of sepsis-induced tissue hypoperfusion, although deemed desirable, are not yet the standard of care as verified by practice data. The publication of the initial results of the international SSC performance improvement program demonstrated that adherence to CVP and S cv O 2 targets for initial resuscitation was low" [57]. As discussed above, these reservations on the Rivers protocol have already been raised by others and are based on its EGDT -early goal directed therapy; ER -emergency room; ICU -intensive care unit; NA -not available, n: number of patients included; *paediatric patients from ER, ward and ICU perceived physiological flaws (having the same targets of CVP in both arms) and on the possibility that the patients of the Rivers study do not represent all septic patients [22].…”