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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.
Crit Care Med. 2010 Apr; 38(4):1036-43.CC

Abstract

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+Show Affiliations

Intensive Care Medicine Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain. acastellanos@humv.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20154597

Citation

Castellanos-Ortega, Alvaro, et al. "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." Critical Care Medicine, vol. 38, no. 4, 2010, pp. 1036-43.
Castellanos-Ortega A, Suberviola B, García-Astudillo LA, et al. 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. Crit Care Med. 2010;38(4):1036-43.
Castellanos-Ortega, A., Suberviola, B., García-Astudillo, L. A., Holanda, M. S., Ortiz, F., Llorca, J., & Delgado-Rodríguez, M. (2010). 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. Critical Care Medicine, 38(4), 1036-43. https://doi.org/10.1097/CCM.0b013e3181d455b6
Castellanos-Ortega A, et al. 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. Crit Care Med. 2010;38(4):1036-43. PubMed PMID: 20154597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Castellanos-Ortega,Alvaro, AU - Suberviola,Borja, AU - García-Astudillo,Luis A, AU - Holanda,María S, AU - Ortiz,Fernando, AU - Llorca,Javier, AU - Delgado-Rodríguez,Miguel, PY - 2010/2/16/entrez PY - 2010/2/16/pubmed PY - 2010/4/10/medline SP - 1036 EP - 43 JF - Critical care medicine JO - Crit Care Med VL - 38 IS - 4 N2 - 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. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/20154597/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_ L2 - https://dx.doi.org/10.1097/CCM.0b013e3181d455b6 DB - PRIME DP - Unbound Medicine ER -