Multicenter Implementation of a Severe Sepsis and Septic Shock Treatment Bundle

Miller, Russell R.; Dong, Lixue; Nelson, Natalie; Brown, Samuel M.; Kuttler, Kathryn G.; Probst, Daniel R.; Allen, Todd L.; Clemmer, Terry P.

doi:10.1164/rccm.201212-2199oc

Cited by 223 publications

(126 citation statements)

References 37 publications

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“…The SSCG has gained popularity all over the world and have been applied in many ICU and the implementation of severe sepsis and septic shock treatment bundle were associated with a marked reduction in hospital mortality [17]. However, the recent failure of promising drugs to further reduce the mortality of septic shock suggests that new approaches are badly needed [18].…”

Section: Discussionmentioning

confidence: 99%

Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter in Patients with Septic Shock: A Preliminary Report

et al. 2014

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Background/Aim: We investigated the clinical efficacy of continuous hemodiafiltration (CHDF) with AN69ST hemofilter (AN69ST-CHDF) in patients with septic shock. Materials and Methods: A prospective, multicenter, single-arm study was conducted. Patients with sepsis and shock defined by hyperlactemia were enrolled. The patients were treated with CHDF and in accordance with the Surviving Sepsis Campaign guidelines (SSCG). Results: Thirty-four patients were enrolled. On ICU admission, the mean blood IL-6 level was 44,800 ± 77,700 pg/ml, and the mean blood lactate level was 69.0 ± 49.4 mg/dl. Both the mean blood IL-6 and lactate levels had significantly decreased to normal ranges after 72 h of AN69ST-CHDF. Though the mean APACHE II score was 32.7 ± 9.8, 28-day survival was 73.5%. Conclusion: The current study suggested that adding AN69ST-CHDF to the treatments outlined in the SSCG might lead to good outcomes for patients with septic shock, probably via the removal of cytokines from the bloodstream.

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Section: Discussionmentioning

confidence: 99%

Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter in Patients with Septic Shock: A Preliminary Report

et al. 2014

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“…Performance improvement efforts for sepsis are associated with improved patient outcomes. An example of this is the Surviving Sepsis Campaign bundles, in which rapid antibiotic administration and fluid resuscitation are associated with lower mortality [4,[118][119][120][121]. Sepsis performance improvement programs should optimally have multiprofessional representation (physicians, nurses, advanced practice providers, pharmacists, respiratory therapists, nutrition support specialists, administrators).…”

Section: Administration/epidemiologymentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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“…2 While mortality in hospital is falling,2 3 4 5 longer term mortality after sepsis has remained high as many patients die in the subsequent months 6. Some argue that this late mortality is simply a reflection of the underlying comorbidity burden of patients who develop sepsis, whereas others argue it is the result of sepsis itself 7…”

Section: Introductionmentioning

confidence: 99%

“…8 Quartin and colleagues, however, showed that risk of mortality remained higher for up to five years after sepsis, even compared with carefully matched controls in hospital with similar burden of comorbidity at baseline 10. Quartin and colleagues, however, assessed patients admitted to hospital in the mid-1980s—before the development of a consensus definition for sepsis11 and before widespread improvements in recognition and treatment of sepsis2 3 4 5—and were able to account for only a limited number of potential confounders. Because of the limitations of existing literature, experts have recently called for additional epidemiological studies of late mortality attributable to sepsis that use patient level data to deal with confounding 12…”

Section: Introductionmentioning

confidence: 99%

Late mortality after sepsis: propensity matched cohort study

Prescott

Osterholzer

Langa

et al. 2016

BMJ

265

214

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Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.Deign Observational cohort study.Setting US Health and Retirement Study.Participants 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.Main outcome measures Late (31 days to two years) mortality and odds of death at various intervals.Results Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.Conclusions More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

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Multicenter Implementation of a Severe Sepsis and Septic Shock Treatment Bundle

Cited by 223 publications

References 37 publications

Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter in Patients with Septic Shock: A Preliminary Report

Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter in Patients with Septic Shock: A Preliminary Report

Surviving sepsis campaign: research priorities for sepsis and septic shock

Late mortality after sepsis: propensity matched cohort study

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