Document Detail


Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study.
MedLine Citation:
PMID:  20154597     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To describe the effectiveness of the Surviving Sepsis Campaign bundles with regard to both implementation and outcome in patients with septic shock and to determine the contribution of the various elements of the bundles to the outcome. DESIGN: Quasi-experimental study with a historical comparison group. SETTING: The three medical-surgical intensive care units of an academic tertiary care center. PATIENTS: A total of 384 adult patients in septic shock were enrolled after the educational intervention (September 2005-August 2008) and 96 patients in the historical group (June 2004-May 2005). INTERVENTION: A hospital-wide quality improvement program based on the implementation of the Surviving Sepsis Campaign guidelines performed between June 2005 and August 2005. MEASUREMENTS AND RESULTS: In-hospital mortality was reduced from 57.3% in the historical group to 37.5% in the intervention group (p = .001). This difference remained significant after controlling for confounding factors (odds ratio, 0.50; 95% confidence interval, 0.28-0.89). The intervention group had also lower length of stay for survivors in the hospital (36.2 +/- 34.8 days vs. 41.0 +/- 26.3 days; p = .043) and in the intensive care units (8.4 +/- 9.8 days vs. 11.0 +/- 9.5 days; p = .004). Improvements in survival were related to the number of bundle interventions completed (p for trend <.001). Compliance with six or more interventions of the 6-hr resuscitation bundle was an independent predictor of survival (adjusted odds ratio, 0.30; 95% confidence interval, 0.17-0.53; p <.001). The only single intervention with impact on mortality was the achievement of ScvO2 > or =70% (adjusted odds ratio, 0.62; 95% confidence interval, 0.38-0.99; p = .048). CONCLUSIONS: The implementation of the Surviving Sepsis Campaign guidelines was associated with a significant decrease in mortality. The benefits depend on the number of interventions accomplished within the time limits. The 6-hr resuscitation bundle showed greater compliance and effectiveness than the 24-hr management bundle.
Authors:
Alvaro Castellanos-Ortega; Borja Suberviola; Luis A García-Astudillo; María S Holanda; Fernando Ortiz; Javier Llorca; Miguel Delgado-Rodríguez
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  38     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-25     Completed Date:  2010-04-09     Revised Date:  2010-09-24    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1036-43     Citation Subset:  AIM; IM    
Affiliation:
Intensive Care Medicine Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain. acastellanos@humv.es
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MeSH Terms
Descriptor/Qualifier:
Academic Medical Centers
Clinical Protocols / standards
Confidence Intervals
Female
Guideline Adherence
Humans
Intensive Care Units / standards
Length of Stay
Male
Middle Aged
Odds Ratio
Outcome Assessment (Health Care)
Shock, Septic / mortality*,  therapy
Treatment Outcome
Comments/Corrections
Comment In:
Crit Care Med. 2010 Apr;38(4):1209-10   [PMID:  20335699 ]
Crit Care Med. 2010 Oct;38(10):2085; author reply 2085   [PMID:  20856010 ]
Crit Care Med. 2010 Oct;38(10):2085-6; author reply 2086   [PMID:  20856008 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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