PURPOSE: To evaluate the impact of implementation of a sepsis “bundle” protocol for the treatment of elderly patients with septic shock on 28-day mortality.
METHODS: We conducted a prospective observational study between May 2004 and February 2007 involving 87 consecutive elderly patients managed according to a sepsis bundle protocol. The protocol consisted of early goal directed therapy, steroids replacement for adrenal insufficiency, intensive insulin therapy, and drotrecogin alfa. Cases were matched for age, source of sepsis, and predicted mortality to a historic group of 87 patients identified between March 2001 and April 2004.
RESULTS: Subjects who were treated according to the sepsis “bundle” had an absolute risk reduction in 28-day mortality of 16% (95% CI -31% to -2%). The treatment group received larger volume of fluid in the first 6 hours of presentation (3960±1990 vs 2490± 1020 ml; p<0.001) and lower doses of vasopressors (maximum dosage of norepinephrine 0.51 μg/kg/min [range] 0.12-1.7 vs 0.98 μg/kg/min [range] 0.15-3.1; p=0.009). A high prevalence of adrenal insufficiency (86%) was identified in the study population. There were no significant differences between the treatment and control groups in the surviving patients with respect to the duration of mechanical ventilation (median 8.5 days [range 1-29] and median 12.0 days [range 1-67], respectively; p=0.07) or ICU length of stay (median 12 days [range 3-41] and median 15 days [range 4-74], respectively; p = 0.08). In multivariate analysis, implementation of the sepsis bundle protocol was independently associated with 28-day improved survival (Adjusted odds ratio .51, 95% CI 0.28-0.94; p=0.03).
CONCLUSION: Older patients with septic shock had an improved 28-day survival rate when treated with a comprehensive sepsis “bundle” protocol.
CLINICAL IMPLICATIONS: our data suggest that older patients with severe sepsis might benefit from aggressive resuscitation. Further customization of the protocol to the elderly population might be required to achieve a further reduction in morbidity related to duration of mechanical ventilation and ICU length of stay.
DISCLOSURE: Morohunfolu Akinnusi, No Financial Disclosure Information; No Product/Research Disclosure Information