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Resuscitation bundle compliance in severe sepsis and septic shock: improves survival, is better late than never.
J Intensive Care Med. 2011 Sep-Oct; 26(5):304-13.JI

Abstract

While clinicians' management of severe sepsis and septic shock has been positively influenced by a number of clinical research studies in the last decade, challenges remain regarding early hemodynamic optimization as envisioned in the Surviving Sepsis Campaign's (SSC) resuscitation bundle (RB). We examined the impact of a hospital-wide continuous quality improvement (CQI) initiative on patients presenting with severe sepsis and septic shock, and the impact of the sepsis RB on patient outcomes when completed beyond the 6-hour recommendation period. The study was an 18-month, prospective cohort study enrolling patients who met the definition of severe sepsis or septic shock. Compliance with the hemodynamic components of the sepsis RB was defined as achieving goal mean arterial pressure (MAP) ≥ 65 mm Hg, central venous pressure (CVP) ≥ 8 mm Hg, and central venous oxygen saturation (ScvO2) ≥ 70%. Compliance was assessed at 6 hours and 18 hours after diagnosis of severe sepsis or septic shock. In all, 498 patients with severe sepsis and/or septic shock were evaluated to determine the upper limit of the range of hours that compliance with the RB would still improve outcomes. Using 18 hours as a marker, Compliers at 18 hrs and Non-Compliers at 18 hrs were compared. There were 202 patients who had the RB completed in less than or equal to 18 hours. There were 296 patients who did not complete the RB at 18 hours. The Compliers at 18 hrs had a significant 10.2% lower hospital mortality 37.1% (22% relative reduction) compared to the Non-Compliers at 18 hrs hospital mortality of 47.3% (P < .03). When the two groups were adjusted for differences in baseline illness severity, the Compliers at 18 hrs had a greater reduction in predicted mortality of 26.8% versus 9.4%, P < 0.01.

CONCLUSIONS

Initiating the sepsis RB for patients with severe sepsis and/or septic shock decreased mortality. A CQI initiative that monitored the implementation in real-time allowed for improvement in compliance and efficacy of the bundle on outcomes. Multiple studies have shown that compliance to the RB within 6 hours lowers hospital mortality. This study uniquely shows that when bundle completion is extended to 18 hours, the mortality reduction remains significant.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Coba V
Department of Emergency Medicine, Detroit, MI, USA Department of Surgery, Trauma and Surgical Critical Care, Detroit, MI, USA. vcoba1@hfhs.org
Whitmill M
Department of Surgery, Trauma and Surgical Critical Care, Detroit, MI, USA.
Mooney R
Department of Quality and Safety, Detroit, MI, USA.
Horst HM
Department of Surgery, Trauma and Surgical Critical Care, Detroit, MI, USA.
Brandt MM
Department of Surgery, Trauma and Surgical Critical Care, Detroit, MI, USA.
Digiovine B
Department of Medicine, Pulmonary Critical Care and Allergy, Detroit, MI, USA.
Mlynarek M
Department of Surgery, Trauma and Surgical Critical Care, Detroit, MI, USA.
McLellan B
Department of Nursing, Detroit, MI, USA.
Boleski G
Department of Nursing, Detroit, MI, USA.
Yang J
Department of Biostatistics and Epidemiology, Detroit, MI, USA.
Conway W
Department of Quality and Safety, Detroit, MI, USA.
Jordan J
Department of Quality and Safety, Detroit, MI, USA.
(The Henry Ford Hospital Sepsis Collaborative Group)
No affiliation info available

MeSH

APACHEAcidosis, LacticAged, 80 and overCohort StudiesFemaleFluid TherapyGuideline AdherenceHospital MortalityHumansHypotensionMaleMiddle AgedOutcome Assessment, Health CareOximetryProspective StudiesQuality ImprovementResuscitationRisk AssessmentSepsisShock, SepticTime-to-TreatmentUnited StatesVasoconstrictor Agents

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21220270

Clinical Trial Links

ED Tracking Sheet Implementation
Electronic Application of a Severe Sepsis Screening Tool and Management Bundle

Citation

Coba, Victor, et al. "Resuscitation Bundle Compliance in Severe Sepsis and Septic Shock: Improves Survival, Is Better Late Than Never." Journal of Intensive Care Medicine, vol. 26, no. 5, 2011, pp. 304-13.
Coba V, Whitmill M, Mooney R, et al. Resuscitation bundle compliance in severe sepsis and septic shock: improves survival, is better late than never. J Intensive Care Med. 2011;26(5):304-13.
Coba, V., Whitmill, M., Mooney, R., Horst, H. M., Brandt, M. M., Digiovine, B., Mlynarek, M., McLellan, B., Boleski, G., Yang, J., Conway, W., & Jordan, J. (2011). Resuscitation bundle compliance in severe sepsis and septic shock: improves survival, is better late than never. Journal of Intensive Care Medicine, 26(5), 304-13. https://doi.org/10.1177/0885066610392499
Coba V, et al. Resuscitation Bundle Compliance in Severe Sepsis and Septic Shock: Improves Survival, Is Better Late Than Never. J Intensive Care Med. 2011 Sep-Oct;26(5):304-13. PubMed PMID: 21220270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resuscitation bundle compliance in severe sepsis and septic shock: improves survival, is better late than never. AU - Coba,Victor, AU - Whitmill,Melissa, AU - Mooney,Roberta, AU - Horst,H Mathilda, AU - Brandt,Mary-Margaret, AU - Digiovine,Bruno, AU - Mlynarek,Mark, AU - McLellan,Beth, AU - Boleski,Gail, AU - Yang,James, AU - Conway,William, AU - Jordan,Jack, AU - ,, Y1 - 2011/01/10/ PY - 2011/1/12/entrez PY - 2011/1/12/pubmed PY - 2015/6/13/medline KW - bundles KW - infection KW - quality improvement KW - sepsis KW - septic shock KW - severe sepsis SP - 304 EP - 13 JF - Journal of intensive care medicine JO - J Intensive Care Med VL - 26 IS - 5 N2 - UNLABELLED: While clinicians' management of severe sepsis and septic shock has been positively influenced by a number of clinical research studies in the last decade, challenges remain regarding early hemodynamic optimization as envisioned in the Surviving Sepsis Campaign's (SSC) resuscitation bundle (RB). We examined the impact of a hospital-wide continuous quality improvement (CQI) initiative on patients presenting with severe sepsis and septic shock, and the impact of the sepsis RB on patient outcomes when completed beyond the 6-hour recommendation period. The study was an 18-month, prospective cohort study enrolling patients who met the definition of severe sepsis or septic shock. Compliance with the hemodynamic components of the sepsis RB was defined as achieving goal mean arterial pressure (MAP) ≥ 65 mm Hg, central venous pressure (CVP) ≥ 8 mm Hg, and central venous oxygen saturation (ScvO2) ≥ 70%. Compliance was assessed at 6 hours and 18 hours after diagnosis of severe sepsis or septic shock. In all, 498 patients with severe sepsis and/or septic shock were evaluated to determine the upper limit of the range of hours that compliance with the RB would still improve outcomes. Using 18 hours as a marker, Compliers at 18 hrs and Non-Compliers at 18 hrs were compared. There were 202 patients who had the RB completed in less than or equal to 18 hours. There were 296 patients who did not complete the RB at 18 hours. The Compliers at 18 hrs had a significant 10.2% lower hospital mortality 37.1% (22% relative reduction) compared to the Non-Compliers at 18 hrs hospital mortality of 47.3% (P < .03). When the two groups were adjusted for differences in baseline illness severity, the Compliers at 18 hrs had a greater reduction in predicted mortality of 26.8% versus 9.4%, P < 0.01. CONCLUSIONS: Initiating the sepsis RB for patients with severe sepsis and/or septic shock decreased mortality. A CQI initiative that monitored the implementation in real-time allowed for improvement in compliance and efficacy of the bundle on outcomes. Multiple studies have shown that compliance to the RB within 6 hours lowers hospital mortality. This study uniquely shows that when bundle completion is extended to 18 hours, the mortality reduction remains significant. SN - 0885-0666 UR - https://www.unboundmedicine.com/medline/citation/21220270/Resuscitation_bundle_compliance_in_severe_sepsis_and_septic_shock:_improves_survival_is_better_late_than_never_ DB - PRIME DP - Unbound Medicine ER -