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Factors Influencing Compliance with Early Resuscitation Bundle in the Management of Severe Sepsis and Septic Shock.
MedLine Citation:
PMID:  23042195     Owner:  NLM     Status:  Publisher    
ABSTRACT: The Surviving Sepsis Campaign (SSC) guidelines recommend implementing a six-hour resuscitation bundle, which has been associated with reduced mortality of patients presenting with severe sepsis or septic shock. However, this resuscitation bundle has not yet become a widely implemented treatment protocol. It is still unclear what factors are associated with the rate of compliance with the resuscitation bundle. In this study, we evaluated the potential factors associated with implementation and compliance of a 6-hour resuscitation bundle in patients presenting with severe sepsis or septic shock in the emergency department (ED). We conducted a retrospective observational study involving adult patients presenting with severe sepsis or septic shock in the emergency department of a tertiary care hospital during the period between August 2008 and July 2010. The resuscitation bundle consisted of seven interventions according to the SSC guidelines. The primary outcome measure was the rate of high compliance with the 6-hour resuscitation bundle, defined as implementation of more than 5 out of 7 interventions. Multivariable logistic regression analysis was used to adjust for the confounding factors. A total of 317 patients were enrolled into the study. 172 (54.3%) patients were assigned to the high compliance group and 145 (45.7%) patients to the low compliance group. Significant factors associated with high compliance of the 6-hour resuscitation bundle were hyperthermia (adjusted odds ratio [OR], 1.37; 95% CI, 1.10 - 1.70), care from experienced nurses who had 3 year or more years of clinical experience (adjusted OR, 1.69; 95% CI, 1.10 - 2.58), and care from senior residents or board-certified emergency physicians (adjusted OR, 3.68; 95% CI, 1.68 - 6.89). Factors related with lower compliance were cryptic shock (adjusted OR, 0.26; 95% CI, 0.13 - 0.52) and higher serum lactate levels (adjusted OR, 0.90; 95% CI, 0.82 - 0.98). Furthermore, we found several potential factors that influence compliance with the sepsis resuscitation bundle. To improve the compliance with the resuscitation bundle, interventions focusing on those factors will be needed.
Mun Ju Kang; Tae Gun Shin; Ik Joon Jo; Kyeongman Jeon; Gee Young Suh; Min Seob Sim; So Yeon Lim; Keun Jeong Song; Yeon Kwon Jeong
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-4
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  -     ISSN:  1540-0514     ISO Abbreviation:  Shock     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 2Divisions of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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