Sepsis Guidelines A Hospital Considering a 1-Hour Bundle for Management of Sepsis (original) (raw)
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Objective: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock, " last published in 2008. Design: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co-and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development.
Controversies in Sepsis Management—What is the Way Forward?
Annals of the Academy of Medicine, Singapore, 2020
Sepsis is life-threatening and might potentially progress from dysregulation to severe organ dysfunction. It is recognised by the World Health Organisation as a global health priority. The mortality rate for sepsis has decreased in many countries, and this is credited to the earlier recognition and treatment of this complex syndrome. In 2002, the Surviving Sepsis Campaign was launched, and there have been several revisions to the sepsis recommendations therefrom. The latest sepsis guidelines focus on viral as well as bacterial infections, and advise that initiating resuscitation and management should take place within one hour from when sepsis is initially suspected. Numerous studies and guidelines pertaining to sepsis management have been published over the past 2 decades. The use of novel therapies and alternative adjunctive therapies has tremendous potential in sepsis management. Debates amongst intensivists exist with the creation of updated sepsis guidelines and advances in tre...
Management of the Sepsis Protocol: An integrative literature review
This study aims to analyze the scientific evidence regarding the management of the Sepsis Protocol from an integrative literature review. This question guided a search in the electronic databases: SciELO, MEDLINE, LILACS and PubMed, all present in the Virtual Health Library and Web of Science. Ten publications were analyzed, from 2017 to 2021. Most of the results indicate that sepsis management is necessary to improve patient management, rapid identification of signs and symptoms and contribute to increasing the effectiveness of the multidisciplinary team. It is concluded that sepsis is a serious pathology, which affects most patients admitted to the Intensive Care Unit. It shows the need for hospital services to standardize and institute sepsis management protocols, since there are currently many existing control mechanisms, involving increasingly sophisticated and low-cost technologies.
Improving Care of the Sepsis Patient
The Joint Commission Journal on Quality and Patient Safety, 2008
Background: In 2004, Christiana Care Health System (Christiana Care), a 1,100-bed tertiary care facility, used the Surviving Sepsis Campaign guidelines as the foundation for an independent initiative to reduce the mortality rate by at least 25%. Methods: In 2004, an interdisciplinary sepsis team developed a process for rapidly recognizing at-risk patients; evaluating a patient's clinical status; and providing appropriate, timely therapy in three major areas of sepsis care; recognition of the sepsis patient, resuscitation priorities, and intensive care management. The Sepsis Alert program, which did not require additional staffing, was developed and implemented in 10 months. The Sepsis Alert packet included a care management guideline, a treatment algorithm, an emergency department treatment order set, and multiple adjuncts to streamline patient identification and management. Results: Introduction of sepsis resuscitation and critical care management standards led to a 49.4% decrease in mortality rates (p < .0001), a 34.0% decrease in average length of hospital stay (p < .0002), and a 188.2% increase in the proportion of patients discharged to home (p < .0001) when the historic control group is compared with the postimplementation group from January 2005 through December 2007. Discussion: An integrated leadership team, using existing resources, transformed frontline clinical practice by providers from multiple disciplines to reduce mortality in the population of patients with sepsis.
Pitfalls in the Treatment of Sepsis
Emergency Medicine Clinics of North America, 2017
Emergency departments (ED) and emergency providers (EPs) have a vital role to play in the treatment and management of septic patients. Indeed, presentation and admission via the ED have been associated with more favorable outcomes. 1,2 However, sepsis care in the ED has also been shown to have quality concerns, which include incorrect antimicrobial choice, delay to diagnosis, and failure to implement evidence-based treatments. 3-5 In this article, the authors describe potential pitfalls in ED sepsis diagnosis and treatment and how to avoid or mitigate them. It should be noted that to avoid redundant content, this is not exhaustive.
ANALYSIS OF THE EFFECTIVENESS FOR DEATH PREVENTION OF PATIENTS INCLUDED IN A SEPSIS PROTOCOL (Atena Editora), 2023
Sepsis is a systemic pro-inflammatory response caused by bacterial, fungal, viral, autoimmune diseases causing dysfunction of one or more organs or systems. In this context, the aim of this study was to compile the literature on the impact of implementing the sepsis protocol on lower mortality and morbidity, to elucidate risk factors and possible interventions. A total of 55 studies were identified according to our search strategy. After applying the adopted inclusion and exclusion criteria, a total of 31 studies in Medline/Pubmed and Medline/BVS were excluded. Then the titles, abstracts and the full text were read, 20 of the 24 references were excluded based on the eligibility criteria. Thus, 4 references were selected for full text evaluation. Finally, four articles were eligible for qualitative evaluation. Despite the early institution of therapeutic measures advocated in the international literature, mortality from sepsis in the institution in question is still high. All references demonstrate the association of better prognosis for early diagnosis of sepsis with respect to protocol adoption, with P-value lower than the significance level = 0.05. This review corroborates that there are still gaps in the treatment of sepsis. However, the implementation of this protocol allows for a better diagnosis of sepsis, reduces possible early sepsis diagnoses, and promotes the effective use of antimicrobial agents in this population. Therefore, we need to investigate more closely the associated risk factors and the implementation of sepsis protocols to obtain a possible effective intervention.
Surviving Sepsis Campaign International.21-
shock (27). The specific components of performance improvement did not appear to be as important as the presence of a program that included sepsis screening and metrics. Sepsis screening tools are designed to promote early identification of sepsis and consist of manual methods or automated use of the electronic health record (EHR). There is wide variation in diagnostic accuracy of these tools with most having poor predictive values, although the use of some was associated with improvements in care processes (28-31). A variety of clinical variables and tools are used for sepsis screening, such as systemic inflammatory response syndrome (SIRS) criteria, vital signs, signs of infection, quick Sequential Organ Failure Score (qSOFA) or Sequential Organ Failure Assessment (SOFA) criteria, National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS) (26, 32). Machine learning may improve performance of screening tools, and in a meta-analysis of 42,623 patients from seven studies for predicting hospital acquired sepsis the pooled area under the receiving operating curve (SAUROC) (0.89; 95% CI, 0.86−0.92); sensitivity (81%; 95% CI, 80−81), and specificity (72%; 95% CI, 72−72) was higher for machine learning than the SAUROC for traditional screening tools such as SIRS (0.70), MEWS (0.50), and SOFA (0.78) (32). Screening tools may target patients in various locations, such as in-patient wards, emergency departments, or ICUs (28-30, 32). A pooled analysis of three RCTs did not demonstrate a mortality benefit of active screening (RR, 0.90; 95% CI, 0.51−1.58) (33-35). However, while there is wide variation in sensitivity and specificity of sepsis screening tools, they are an important component of identifying sepsis early for timely intervention. Standard operating procedures are a set of practices that specify a preferred response to specific clinical circumstances (36). Sepsis standard operating procedures, initially specified as Early Goal Directed Therapy have evolved to "usual care" which includes a standard approach with components of the sepsis bundle, early identification, lactate, cultures, antibiotics, and fluids (37). A large study examined the association between implementation of state-mandated sepsis protocols, compliance, and mortality. A retrospective cohort study of 1,012,410 sepsis admissions to 509 hospitals in the United States in a retrospective cohort examined mortality before (27 months) and after (30 months) implementation of New York state sepsis regulations, with a concurrent control population from four other states (38). In this comparative interrupted time series, mortality was lower in hospitals with higher compliance with achieving the sepsis bundles successfully. Lower resource countries may experience a different effect. A meta-analysis of two RCTs in Sub-Saharan Africa found higher mortality (RR, 1.26; 95% CI, 1.00−1.58) with standard operating procedures compared with usual care, while it was decreased in one observational study (adjusted hazard ratio [HR]; 95% CI, 0.55−0.98) (39).