Difficulties in implementation of the recommendations for the diagnosis and treatment of severe sepsis and septic shock
Authors:
Firment Jozef; Hudák Vladimír; Grendel Tomáš
Authors‘ workplace:
Oddelenie anesteziológie a intenzívnej medicíny, FN LP a LF UPJŠ Košice, Slovenská republika
Published in:
Anest. intenziv. Med., 19, 2008, č. 5, s. 252-259
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
Severe sepsis and septic shock are most important factors of high morbidity and mortality in critically ill patients. The aim of our study was to assess the implementation of the recommendations for the diagnosis and treatment of severe sepsis and septic shock in our department according to the Surviving Sepsis Campaign.
Setting:
University Department of Anaesthesiology & Intensive Care Medicine.
Materials and methods:
The 2004 patients were enrolled retrospectively, 2004 being the year of implementation of the recommendations. Since 2005 we have been enrolling patients prospectively with the recommendations fully in force.
Results:
Between 2004 and 2006, 1293 patients were admitted to the ICU; 103 (8%) of them were diagnosed with severe sepsis or septic shock. The mortality by year was as follows: 72% in 2004, 63% in 2005 and 61% in 2006. All the steps of the resuscitation bundles were completed in 7% patients in 2004, in 16% patients in 2005 and in 11% patients in 2006. The 24-hour management bundle steps were completed in no patient in 2004 and 2005, and in 56% patients in 2006. When assessing the 100% implementation of the bundles, one of the aims of the Surviving Sepsis Campaign, we found that in 2004 and 2005 we did not meet the criteria of complete implementation in any patient and in 2006 we met the criteria in 8% patients.
Conclusion:
The implementation of the Surviving Sepsis Campaign bundles to everyday practice is a long-term process. The high mortality in septic patients is explained by the development of septic shock at the time of initiating the standardized therapy.
Key words:
severe sepsis – septic shock – critically ill patient
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2008 Issue 5
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