Mortality rate reduction associated with a severe sepsis management protocol implementation

Introduction

The Surviving Sepsis Campaign is an international effort to reduce severe-sepsis-associated mortality. We have decided to implement the recommendations proposed by the Campaign through a management protocol in our institution.

Objective

To describe the impact of the Surviving Sepsis Campaign recommendations on mortality in severe sepsis patients admitted to the ICU.

Methods

The study was conducted within the emergency department and ICU of a tertiary hospital in Brazil. A management protocol for the care of severe sepsis and septic shock based on the Surviving Sepsis Campaign guidelines was implemented by a 'sepsis' team comprising emergency department physicians, pharmacists, and critical care physicians, chaired by a coordinator. Also, we have used the individual collected data proposed by the Surviving Sepsis Campaign to obtain information about quality indicators.

Results

A total of 160 patients with septic shock were identified. Ninety-four patients were managed before the implementation of the standardized protocol, constituting the Control group, and 66 patients were evaluated after the implementation of the standardized protocol (Intervention group). Demographic variables and severity of illness scores (APACHE II and SOFA) were similar for both groups. Patients in the Intervention group showed statistically significant larger numbers of cultures obtained, earlier antibiotics and a more rigorous glucose control. In addition, those patients received more corticoids and activated protein C. The ICU and hospital lengths of stay were similar in both groups. The hospital mortality rate was significantly lower in the after group (56.4% vs 37.9%, P < 0.05).

Conclusion

The implementation of the Surviving Sepsis Campaign guidelines through a standardized protocol was associated with improved patient care and a reduction in severe-sepsis-related mortality.