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THE IMPACT OF IMPLEMENTING SEVERE SEPSIS MANAGEMENT GUIDELINES ON MORTALITY IN A COMMUNITY-BASED TEACHING HOSPITAL FREE TO VIEW

Maged A. Tanios, MD, MPH*; Melanie Zabow, MD; Scott K. Epstein, MD, FCCP
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St. Mary Medical Center/Harbor-UCLA, Long Beach, CA


Chest


Chest. 2007;132(4_MeetingAbstracts):494a. doi:10.1378/chest.132.4_MeetingAbstracts.494a
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Abstract

PURPOSE: Severe Sepsis mortality is exceedingly high. Implementing the Surviving Sepsis Campaign (SSC) guidelines can be challenging and its feasibility and benefit in community-based hospitals has not been validated.

METHODS: An education program including lecture series, daily rounds, guidelines reinforcement, and screening charts and placing guidelines reminder. Charts were reviewied as identified by ICD-9 diagnoses.

RESULTS: 96 pts with severe sepsis (34 controls and 62 SSC group). Both groups had similar Apache scores [28 (21, 34) vs. 29 (21; 36), p>0.2] diagnoses and gender (58 v. 46 %male p>0.2) but the control group was younger [66 (53, 73) v 74yrs (60, 82) p: 0.017]. Of the SSC guidelines, early initial resuscitation was achieved in 86% of SCC groups v. 64% of controls (p: 0.03) and they received more fluid therapy in the first 3 hours of resuscitation: 3L (1, 4) v. vs 2 (1, 2.7)(p: 0.006). Compared to controls, SSC gp had more use of norepinephrine as the preferred agent (27 v. 9%), assessing for relative adrenal insufficiency (61 v. 23%), and implementing DVT (85 v. 62%) and stress ulcer prophylaxis (97 v. 76%)(p <0.05 for all). SSC patients has shorter time-in-shock [10(1, 25) v. 22hrs(14, 33) p=0.002. Both groups had similar ICU-length of stay (3 (2, 5) v. 3dys (2, 6) (p>0.2). Patients who required mechanical ventilation (MV) had similar MV time (3 (3, 7) v. 4dys (2, 8)(p>0.2); SSC gp had a shorter ICU-LOS in patient who did not require MV, [2 (2, 4) v. 3dys (2 , 4) (p>0.2)]. A robust survival benefit favored the SSC gp 73% v. 45% (p=0.006). Multivariate analysis model controlling for age, gender, APACHE, and diagnoses confirmed that implementing SSC guidelines was independent predictor for survival but none of the interventions individually reached statistical significance.

CONCLUSION: Sepsis management guidelines confers robust survival benefit that did not adversely affect ICU utilization in a community-based teaching hospital.

CLINICAL IMPLICATIONS: Implementing severe sepsis managment guidelines by an intensive educational program is a feasible method.

DISCLOSURE: Maged Tanios, None.

Wednesday, October 24, 2007

10:30 AM - 12:00 PM


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