Prompt recognition of septic shock, early-goal directed therapy, and timely antibiotic administration have demonstrated to impact outcome in septic shock. In addition, research continues to identify a low compliance to the Surviving Sepsis Campaign (SCC) guidelines. The aim of this study was to evaluate the impact of a new sepsis management program on the survival of patients with septic shock.
A prospective, observational study comparing two groups of patients before and after the implementation of our sepsis management program was conducted in two intensive care units and Emergency Department (ED). Patient demographics, APACHE II, fluid resuscitation, timing of antimicrobials, and mortality were collected. The pre-intervention group consisted of 64 patients with septic shock. The post-intervention group included 54 patients. The sepsis management program consisted of monthly educational sessions on septic shock recognition and management order sets for fluid resuscitation, antibiotics, and vasopressors. In addition, pre/post surveys were administered to 240 ED and ICU clinicians to determine the impact of the SCC goals.
The survey results demonstrated an increase in awareness of fluid administration goals (before 39% versus after 61%) and overall familiarity with the SCC guidelines (before 37% versus after 63%). The overall mortality rate was lower in the second group compared to the first group, 39% vs 56.25% (p=0.06). Patients in the post-intervention group were more likely to receive appropriate antibiotic therapy (78% vs 51.5%, p=0.003) and adequate fluid resuscitation in the first 6 hrs from the time of refractory hypotension (72% vs 31%, p<0.0001). APACHE II scores were similar in the two groups (mean 27.4 vs 27.04).
The educational sessions and the use of sepsis order sets are simple and effective ways to improve the quality of care and outcomes for patients with septic shock.
The clinical implications of this study are beneficial to health-care institutions by providing strategies and principles of care for patients with septic shock. The implementation of these strategies improves patient survival.
Gourang Patel, No Financial Disclosure Information; No Product/Research Disclosure Information