Critical Care: Sepsis II |

Early Clinical Presentation of Sepsis and Adherence to Surviving Sepsis Campaign Bundles FREE TO VIEW

Veronica Esmero, MD; Chan Pu, MD; Steven Quinn, MD; Hemil Gonazalez, MD; Monika Kakol, MD; Jorge Morales, MD; Renaud Gueret, MD; Jared Greenberg, MD
Author and Funding Information

Rush University Medical Center, Chicago, IL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):368A. doi:10.1016/j.chest.2016.08.381
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Sepsis is a frequent reason for ICU admission and in-hospital death. Interventions that improve mortality, such as appropriate antibiotics and fluid resuscitation, rely on timely recognition of the disease process. Our objective was to determine the patient characteristics that influence adherence to the Surviving Sepsis Campaign (SSC) bundles.

METHODS: We conducted a retrospective review of adult patients with sepsis admitted from the Emergency Room to the Intensive Care Unit at two hospitals in Chicago, Illinois over a one-year period (Rush University Medical Center and John H, Stroger, Jr. Hospital of Cook County). Patients were screened for sepsis using the ICD-9 discharge search strategy described by Angus et al. For patients who screened positive, their charts were manually reviewed and they were included if they met Sepsis-3 criteria. Patient characteristics and the timing of acute organ failure over the first 24 hours were recorded. The primary outcomes were adherence to the SSC bundles and in-hospital mortality.

RESULTS: Among an initial evaluation of 49 patients who screened positive for sepsis at Rush University Medical Center and died during the hospitalization, 29 (59%) met Sepsis-3 criteria. Within three hours of Emergency Room admission, there were 19 (66%) who had blood cultures drawn, 18 (62%) who had broad-spectrum antibiotics started, and 16 (55%) who had lactate measured. Complete adherence to these three measures was more likely to occur in patients with hypotension and/or a lactate ≥4mm/L in the first three hours (OR 9.16, 95% CI 1.49-56, p=0.02). Of the 16 patients with hypotension and/or elevated lactate, 10 (63%) received an appropriate 30 ml/kg crystalloid bolus. There were 9 (31%) who met all of the recommended processes of care within 3 hours of presentation.

CONCLUSIONS: Most patients with sepsis receive each of the first four recommended SSC bundles in the Emergency Room, but most do not receive all bundles within 3 hours of presentation. The presence of hypotension or elevated lactate may lead to easier recognition of the disease process and timelier delivery of care.

CLINICAL IMPLICATIONS: Improved adherence to the SCC bundles and sepsis-related mortality may occur with a greater understanding of the types of patients who are unlikely to be recognized as having sepsis in the first 3 hours.

DISCLOSURE: The following authors have nothing to disclose: Veronica Esmero, Chan Pu, Steven Quinn, Hemil Gonazalez, Monika Kakol, Jorge Morales, Renaud Gueret, Jared Greenberg

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