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The severe sepsis bundles as processes of care: a meta-analysis.
Aust Crit Care. 2011 Nov; 24(4):229-43.AC

Abstract

OBJECTIVE

The use of the sepsis bundles in patients with severe sepsis and septic shock has been controversial in the last decade. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate survival effects.

DATA SOURCE

Database searches (2004-current) of Medline, CINAHL, Pubmed, Cochrane, Scopus and Google scholar databases which covered full publications, abstracts from conferences and digital thesis were performed using the search terms sepsis, septic shock and/or bundles, processes of care, guidelines, early goal directed therapy, resuscitation.

RESULTS

From 253 identified studies, 21 sepsis bundle original studies were selected and included 23,438 patients. The Resuscitation 6 hour Bundle pooled analysis (1819 patients) achieved the greatest survival benefit (odds ratio (OR) 2.124, 95% CI 1.701-2.651, p<0.000) with the Management 24 hour Bundle pooled analysis the lowest survival benefit (16,521 patients) (OR 1.646, 95% CI 1.036-2.614, p<0.035). Both bundles together (Complete Bundle) achieved a combined survival benefit (OR 1.744, 95% CI 1.421-2.141, p<0.000). ScvO2 and blood glucose components were analysed individually to assess their contribution to survival.

CONCLUSION

The Resuscitation 6 hour bundle in the context of the patient population at hand is unlikely to do harm and is yet to be established in primary research in Australia. The Management 24 hour Bundle could not establish a strong enough survival benefit above current routine practice. The sepsis guidelines and bundles have demanded more credible process measurements and debate to induce positive changes in the intervention and treatment care of patients with severe sepsis.

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Authors+Show Affiliations

Chamberlain DJ
Flinders University, School of Nursing & Midwifery, Faculty of Health Sciences, GPO Box 2100, Adelaide, SA 5001, Australia. Di.Chamberlain@flinders.edu.au
Willis EM
No affiliation info available
Bersten AB
No affiliation info available

MeSH

Critical CareGuideline AdherenceHumansOutcome and Process Assessment, Health CarePractice Guidelines as TopicResuscitationSepsisSeverity of Illness IndexShock, SepticSurvival Analysis

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

21324711

Citation

Chamberlain, Diane J., et al. "The Severe Sepsis Bundles as Processes of Care: a Meta-analysis." Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses, vol. 24, no. 4, 2011, pp. 229-43.
Chamberlain DJ, Willis EM, Bersten AB. The severe sepsis bundles as processes of care: a meta-analysis. Aust Crit Care. 2011;24(4):229-43.
Chamberlain, D. J., Willis, E. M., & Bersten, A. B. (2011). The severe sepsis bundles as processes of care: a meta-analysis. Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses, 24(4), 229-43. https://doi.org/10.1016/j.aucc.2011.01.003
Chamberlain DJ, Willis EM, Bersten AB. The Severe Sepsis Bundles as Processes of Care: a Meta-analysis. Aust Crit Care. 2011;24(4):229-43. PubMed PMID: 21324711.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The severe sepsis bundles as processes of care: a meta-analysis. AU - Chamberlain,Diane J, AU - Willis,Eileen M, AU - Bersten,Andrew B, Y1 - 2011/02/15/ PY - 2010/07/09/received PY - 2010/12/14/revised PY - 2011/01/11/accepted PY - 2011/2/18/entrez PY - 2011/2/18/pubmed PY - 2012/3/1/medline SP - 229 EP - 43 JF - Australian critical care : official journal of the Confederation of Australian Critical Care Nurses JO - Aust Crit Care VL - 24 IS - 4 N2 - OBJECTIVE: The use of the sepsis bundles in patients with severe sepsis and septic shock has been controversial in the last decade. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate survival effects. DATA SOURCE: Database searches (2004-current) of Medline, CINAHL, Pubmed, Cochrane, Scopus and Google scholar databases which covered full publications, abstracts from conferences and digital thesis were performed using the search terms sepsis, septic shock and/or bundles, processes of care, guidelines, early goal directed therapy, resuscitation. RESULTS: From 253 identified studies, 21 sepsis bundle original studies were selected and included 23,438 patients. The Resuscitation 6 hour Bundle pooled analysis (1819 patients) achieved the greatest survival benefit (odds ratio (OR) 2.124, 95% CI 1.701-2.651, p<0.000) with the Management 24 hour Bundle pooled analysis the lowest survival benefit (16,521 patients) (OR 1.646, 95% CI 1.036-2.614, p<0.035). Both bundles together (Complete Bundle) achieved a combined survival benefit (OR 1.744, 95% CI 1.421-2.141, p<0.000). ScvO2 and blood glucose components were analysed individually to assess their contribution to survival. CONCLUSION: The Resuscitation 6 hour bundle in the context of the patient population at hand is unlikely to do harm and is yet to be established in primary research in Australia. The Management 24 hour Bundle could not establish a strong enough survival benefit above current routine practice. The sepsis guidelines and bundles have demanded more credible process measurements and debate to induce positive changes in the intervention and treatment care of patients with severe sepsis. SN - 1036-7314 UR - https://www.unboundmedicine.com/medline/citation/21324711/The_severe_sepsis_bundles_as_processes_of_care:_a_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1036-7314(11)00004-X DB - PRIME DP - Unbound Medicine ER -