Mortality rate reduction associated with severe sepsis and septic shock management protocol implementation

Constantino José Fernandes Junior, Alexandre Gonçalves de Sousa, Gisele de Paula Dias Santos, Eliezer Silva and Nelson Akamine

Hospital Israelita Albert Einstein Division of Medical Practice – Department of Protocols, São Paulo, Brazil

from Sepsis 2007
Paris, France. 26–29 September 2007

Critical Care 2007, 11(Suppl 4):P11doi:10.1186/cc5990

The electronic version of this abstract is the complete one and can be found online at: http://ccforum.com/content/11/S4/P11

Published:

26 September 2007

Background

The Surviving Sepsis Campaign is an international effort to reduce severe sepsis and septic shock associated mortality by 25% in 5 years. We developed a management protocol in our institution 2 years ago in order to follow the proposed recommendations of this campaign, and describe the clinical impact of assuming this critical pathway on the mortality rate.

Materials

The study was conducted within the emergency department and intensive care unit of a tertiary hospital. A management protocol for severe sepsis and septic shock was based on the Surviving Sepsis Campaign guidelines and was implemented by a 'sepsis' team including emergency department and critical care physicians, intensive care nurses and pharmacists, chaired by a full-time coordinator.

Methods

We performed a 'before and after' evaluation of the critical pathway concerning 184 critically ill patients sequentially admitted throughout a 16-month period.

Results

A total of 184 patients with severe sepsis or septic shock entered the study. Ninety-four patients had their analysis performed before the implementation of the standardized protocol (the 'before' group), and 90 patients were managed following the implementation of the protocol (the 'after' group). Basal demographic variables and the severity of illness score (APACHE II) were similar for both groups.

Patients in the 'after' group had statistically more cultures obtained before institution of antibiotics and more patients received antibiotics in a due time (2 hours from diagnosis). In addition, those patients received more corticosteroids and activated protein C (Table 1).

Table 1. Proceedings concerning 'before' versus 'after' groups

The intensive care unit length of stay and the hospital length of stay were similar in both groups. Remarkably the hospital mortality rate was significantly lower (34.4%) in the 'after' group in septic shock patients (67.7% versus 44.4%, P < 0.04) (Figure 1).

Figure 1. Mortality rate reduction in septic shock patients (42 deaths in 'before' group versus 32 deaths in 'after' group). P < 0.04.

Conclusion

The implementation of the Surviving Sepsis Campaign guidelines through a standardized protocol was associated with a 34% reduction in septic shock-related hospital mortality.

This article is part of the supplement: Sepsis 2007