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Mortality Reduction and Long-Term Compliance with Surviving Sepsis Campaign: A Nationwide Multicenter Study
Rubén Herrán-Monge1, Arturo Muriel-Bombín, Marta M García-García
1*Intensive Care Unit, Hospital Universitario Río Hortega, Spain†Intensive Care Unit, Hospital Clínico Universitario, Valladolid, Spain‡Intensive Care Unit, Hospital Universitario de Burgos, Burgos, Spain§Intensive Care Unit, Complejo Hospitalario de Salamanca, Salamanca, Spain||Intensive Care Unit, Complejo Hospitalario de León, León, Spain¶Intensive Care Unit, Hospital Río Carríon, Palencia, Spain#Intensive Care Unit, Hospital El Bierzo, Ponferrada, León, Spain**Intensive Care Unit, Hospital General de Segovia, Segovia, Spain††Intensive Care Unit, Complejo Hospitalario de Soria, Soria, Spain‡‡Intensive Care Unit, Hospital Virgen de la Concha, Zamora, Spain§§CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain||||Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain¶¶Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Purpose:
To determine the long-term degree of compliance with the Surviving Sepsis Campaign (SSC) bundles and related outcomes after an educational program in septic patients admitted to a network of intensive care units (ICU).
Methods:
Prospective, observational, multicenter study in several ICUs during a 5-month period for evaluating the degree of compliance with the SSC bundles of resuscitation in the first 6 h (B6H) and management in the following 24 h (B24H). We compared the findings with those from a historical cohort at the same ICUs after an educational program (EDUSEPSIS) 5 years earlier.
Results:
The study cohort comprised 231 episodes of severe sepsis and the historical cohort included 217. In the current cohort, we found a better compliance with B6H compared with the historical cohort (27.7% vs. 9.7%, P < 0.001), and lower compliance with B24H (4.3% vs. 12.9%, P < 0.001). ICU and in-hospital mortalities were reduced from 37.3% to 27.1% (P = 0.02) and from 45.3% to 36.7% (P = 0.06), respectively. This reduction occurred linearly with the number of B6H items completed (P for trend <0.001). All B6H measures were individually associated with lower ICU mortality. Measurement of plasma lactate, blood cultures, and administration of broad-spectrum antibiotics were associated with lower in-hospital mortality. No benefit was observed regarding B24H.
Conclusions:
Our study confirmed that an educational campaign aimed at early recognition and management of patients with severe sepsis improves compliance with management recommendations and hospital survival in the long term.
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