Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department.

Carvas, João Miguel; Canelas, Cátia; Montanha, Gustavo M; Silva, Carlos; Esteves, Francisco

doi:10.20344/amp.6998

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…Other observational and quasiexperimental studies reported similar results (40,55,(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92). When EGDT was incorporated into a clinical pathway for the treatment of severe sepsis and septic shock, hospital mortality could be decreased (93).…”

Section: Compliance With Surviving Sepsis Campaign (Ssc) Bundlementioning

confidence: 61%

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

et al. 2017

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Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.

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Section: Compliance With Surviving Sepsis Campaign (Ssc) Bundlementioning

confidence: 61%

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

et al. 2017

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“…Additionally, a retrospective, observational cohort learn about performed by using Carvas et al (2016) performed in Portugal among 178 patients in ED patients using a questionnaire. The study outcomes revealed that compliance with the sepsis bundle was 62.9% for lactate measurement, 62.9% for blood cultures earlier than antibiotics, 41.6% for antibiotics in the first three hours, 76.4% for fluid administration, 25% for vasopressor administration, 37% for central venous pressure measurement and, 39% for central venous oxygen saturation measurement.…”

Section: Administer Intravenous Fluidmentioning

confidence: 99%

Impact of Septic Bundle on Critically Ill Patients Outcomes: Scoping Review

Rehbeini¹

2020

TIJNR

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Objective: This review is aimed to evaluate the effect of implementing the septic bundle on critically ill patients’ outcomes. Methodology: Cochrane Collaboration, MEDLINE, CINAHL, EMBASE, Science Direct, Web of Science, Scopus and PubMed were searched, covering the period 2008 to 2019. Only cohort, case-control and randomized controlled trial studies with full text in English were eligible. Studies that discussed the effect of implementing the septic bundle on critically ill patients' outcomes were only included. Results: Out of 1,551 articles searched, and after screening inclusion and exclusion criteria; ten articles only were met the inclusion criteria which have considered the effect of implementing a septic bundle on critically ill patients’ outcomes. All of these ten studies revealed a significant effect of the septic bundle on the clinical outcomes of critically ill patients especially mortality. Conclusion: This review confirmed that implementing septic bundle for critically ill patients has been significantly reduced outcomes which are length of hospital stay, length of stay at emergency department, mortality probability, admission to the intensive care unit and mechanical ventilation.

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Nonadherence to antibiotic guidelines in patients admitted to ICU with sepsis is associated with increased mortality

Lindberg

Geer

Chew

2020

European Journal of Anaesthesiology

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BACKGROUND Early appropriate antibiotic therapy is an important component of the Surviving Sepsis Guidelines bundles that are associated with decreased in-hospital mortality. National antibiotic guidelines for the treatment of sepsis in Sweden have been available since 2008. Compliance with these guidelines is largely unknown, and whether it translates to improved patient outcome has not been studied. OBJECTIVE To assess mortality and its relationship to compliance with Swedish antibiotic guidelines. A secondary aim was to assess the effect of timing of antibiotic administration and mortality. DESIGN A registry-based, retrospective cohort study. Registry data were supplemented by manual extraction of data on antibiotic treatment from patient charts. The association between guideline compliance and mortality was evaluated using multivariable analysis. Three levels of compliance were predefined: full compliance – correct antibiotics and dose; partial compliance – correct antibiotic but wrong dose and/or wrong initial antibiotic but corrected within 24 h and/or wrong combination in a combined regime that is at least one antibiotic not in line with the national antibiotic guideline; no compliance – incorrect antibiotic. SETTING Two general ICUs in Sweden between 1 January 2011 and 31 December 2015. PATIENTS Seven hundred and thirteen patients over the age of 18 with severe sepsis or septic shock identified through the Swedish ICU Registry. MAIN OUTCOME MEASURES The primary outcome was 30-day mortality. RESULTS Full compliance was observed in 47.0% of patients, partial compliance in 36.0%, and no compliance in 17.0%. Lack of compliance was independently associated with increased risk of 30-day mortality: the adjusted hazard ratio was 1.86 (95% CI 1.34 to 2.58 P < 0.001) for partial compliance and 2.18 (95% CI 1.34 to 3.40 P < 0.001) for no compliance. The time to first antibiotic administration was not associated with mortality. CONCLUSION Less than half of the patients with severe sepsis and septic shock received antibiotics according to Swedish national guidelines. Full compliance with the guidelines was associated with decreased mortality. The results of this study show that a strict approach to guideline compliance seems to be beneficial: half measures and inadequate doses should be avoided.

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Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department.

Cited by 4 publications

References 13 publications

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

Impact of Septic Bundle on Critically Ill Patients Outcomes: Scoping Review

Nonadherence to antibiotic guidelines in patients admitted to ICU with sepsis is associated with increased mortality

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