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Factors influencing compliance with early resuscitation bundle in the management of severe sepsis and septic shock.
Shock. 2012 Nov; 38(5):474-9.S

Abstract

The Surviving Sepsis Campaign guidelines recommend implementing a 6-h resuscitation bundle, which has been associated with reduced mortality of patients presenting with severe sepsis or septic shock. However, this resuscitation bundle has not yet become a widely implemented treatment protocol. It is still unclear what factors are associated with the rate of compliance with the resuscitation bundle. In this study, we evaluated the potential factors associated with implementation and compliance of a 6-h resuscitation bundle in patients presenting with severe sepsis or septic shock in the emergency department. We conducted a retrospective observational study involving adult patients presenting with severe sepsis or septic shock in the emergency department of a tertiary care hospital during the period between August 2008 and July 2010. The resuscitation bundle consisted of seven interventions according to the Surviving Sepsis Campaign guidelines. The primary outcome measure was the rate of high compliance with the 6-h resuscitation bundle, defined as implementation of more than five of seven interventions. Multivariable logistic regression analysis was used to adjust for the confounding factors. A total of 317 patients were enrolled into the study. One hundred seventy-two patients (54.3%) were assigned to the high compliance group, and 145 patients (45.7%) to the low compliance group. Significant factors associated with high compliance of the 6-h resuscitation bundle were hyperthermia (adjusted odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.10-1.70), care from experienced nurses who had 3 or more years of clinical experience (adjusted OR, 1.69; 95% CI, 1.10-2.58), and care from senior residents or board-certified emergency physicians (adjusted OR, 3.68; 95% CI, 1.68-6.89). Factors related with lower compliance were cryptic shock (adjusted OR, 0.26; 95% CI, 0.13-0.52) and higher serum lactate levels (adjusted OR, 0.90; 95% CI, 0.82-0.98). Furthermore, we found several potential factors that influence compliance with the sepsis resuscitation bundle. To improve the compliance with the resuscitation bundle, interventions focusing on those factors will be needed.

Authors+Show Affiliations

Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.No affiliation info availableNo affiliation info availableNo 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

Language

eng

PubMed ID

23042195

Citation

Kang, Mun Ju, et al. "Factors Influencing Compliance With Early Resuscitation Bundle in the Management of Severe Sepsis and Septic Shock." Shock (Augusta, Ga.), vol. 38, no. 5, 2012, pp. 474-9.
Kang MJ, Shin TG, Jo IJ, et al. Factors influencing compliance with early resuscitation bundle in the management of severe sepsis and septic shock. Shock. 2012;38(5):474-9.
Kang, M. J., Shin, T. G., Jo, I. J., Jeon, K., Suh, G. Y., Sim, M. S., Lim, S. Y., Song, K. J., & Jeong, Y. K. (2012). Factors influencing compliance with early resuscitation bundle in the management of severe sepsis and septic shock. Shock (Augusta, Ga.), 38(5), 474-9. https://doi.org/10.1097/SHK.0b013e31826eea2b
Kang MJ, et al. Factors Influencing Compliance With Early Resuscitation Bundle in the Management of Severe Sepsis and Septic Shock. Shock. 2012;38(5):474-9. PubMed PMID: 23042195.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors influencing compliance with early resuscitation bundle in the management of severe sepsis and septic shock. AU - Kang,Mun Ju, AU - Shin,Tae Gun, AU - Jo,Ik Joon, AU - Jeon,Kyeongman, AU - Suh,Gee Young, AU - Sim,Min Seob, AU - Lim,So Yeon, AU - Song,Keun Jeong, AU - Jeong,Yeon Kwon, PY - 2012/10/9/entrez PY - 2012/10/9/pubmed PY - 2013/3/12/medline SP - 474 EP - 9 JF - Shock (Augusta, Ga.) JO - Shock VL - 38 IS - 5 N2 - The Surviving Sepsis Campaign guidelines recommend implementing a 6-h resuscitation bundle, which has been associated with reduced mortality of patients presenting with severe sepsis or septic shock. However, this resuscitation bundle has not yet become a widely implemented treatment protocol. It is still unclear what factors are associated with the rate of compliance with the resuscitation bundle. In this study, we evaluated the potential factors associated with implementation and compliance of a 6-h resuscitation bundle in patients presenting with severe sepsis or septic shock in the emergency department. We conducted a retrospective observational study involving adult patients presenting with severe sepsis or septic shock in the emergency department of a tertiary care hospital during the period between August 2008 and July 2010. The resuscitation bundle consisted of seven interventions according to the Surviving Sepsis Campaign guidelines. The primary outcome measure was the rate of high compliance with the 6-h resuscitation bundle, defined as implementation of more than five of seven interventions. Multivariable logistic regression analysis was used to adjust for the confounding factors. A total of 317 patients were enrolled into the study. One hundred seventy-two patients (54.3%) were assigned to the high compliance group, and 145 patients (45.7%) to the low compliance group. Significant factors associated with high compliance of the 6-h resuscitation bundle were hyperthermia (adjusted odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.10-1.70), care from experienced nurses who had 3 or more years of clinical experience (adjusted OR, 1.69; 95% CI, 1.10-2.58), and care from senior residents or board-certified emergency physicians (adjusted OR, 3.68; 95% CI, 1.68-6.89). Factors related with lower compliance were cryptic shock (adjusted OR, 0.26; 95% CI, 0.13-0.52) and higher serum lactate levels (adjusted OR, 0.90; 95% CI, 0.82-0.98). Furthermore, we found several potential factors that influence compliance with the sepsis resuscitation bundle. To improve the compliance with the resuscitation bundle, interventions focusing on those factors will be needed. SN - 1540-0514 UR - https://www.unboundmedicine.com/medline/citation/23042195/Factors_influencing_compliance_with_early_resuscitation_bundle_in_the_management_of_severe_sepsis_and_septic_shock_ L2 - https://doi.org/10.1097/SHK.0b013e31826eea2b DB - PRIME DP - Unbound Medicine ER -