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Critical Care  2009 

Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: a pilot study

DOI: 10.1186/cc8029

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Abstract:

This prospective observational cohort study included 67 patients with severe sepsis/septic shock admitted to a multidisciplinary ICU at a University Hospital from January 2005 to June 2007. Compliance to 5 resuscitation and 4 management sepsis interventions and in-hospital mortality were measured following an educational program on sepsis for physician and nurses of all hospital departments and hospital implementation of a specific protocol for recognition and management of patients with severe sepsis/septic shock, including an early consultation by a skilled 'sepsis team'.During the study period, the compliance to all 9 interventions increased from 8% to 35% of the patients (P < 0.01). The implementation of resuscitation and management interventions was associated with a lower risk of in-hospital mortality (23% vs 68% and 27% vs 68%, P < 0.01). In the latter 2 semesters, after activation of the 'sepsis team', in-hospital mortality of ICU septic shock patients decreased by about 40% compared with the previous period (32% vs 79%, P < 0.01).In our experience, an in-hospital sepsis program, including education of health-care personnel and process-changes, improved the adherence to guidelines and the survival rate of patients with severe sepsis/septic shock admitted to the ICU.The high incidence, costs and mortality rate of patients with sepsis in the recent years has led the critical care scientific community to develop specific strategies aimed to improve the outcome of these patients [1-4]. In 2004, the Surviving Sepsis Campaign (SSC) guidelines [3] recommended a series of diagnostic and therapeutic interventions whose implementation was expected to lead to a survival benefit in patients with severe sepsis/septic shock. Afterwards, to facilitate the application of these guidelines in clinical practice, the Institute for Healthcare Improvement (IHI) proposed the severe sepsis resuscitation (6-hours) and management (24-hours) bundles, that integrate the interventions d

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