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Association between 1-h bundle and clinical outcomes in patients with sepsis: A systematic review and meta-analysis
Shukun Hong1, Hongye Wang2, Jian Liu1
1Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China; Clinical Research Center of Dongying Critical Care Medicine, Dongying, China.
Insights
The 1-hour sepsis bundle significantly reduces short-term mortality in patients. Implementing this sepsis bundle in intensive care units (ICUs) shows promising results for improved patient survival.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Public Health
Background:
- Sepsis is a life-threatening condition requiring timely and effective treatment.
- The 1-hour bundle is a set of evidence-based interventions designed for rapid sepsis management.
- Comparing the 1-hour bundle with non-standard care is crucial for optimizing sepsis protocols.
Purpose of the Study:
- To systematically review and meta-analyze the clinical impact of the 1-hour bundle versus non-1-hour bundle protocols in sepsis patients.
- To assess the effect of the 1-hour bundle on short-term mortality and other clinical outcomes.
Main Methods:
- A systematic literature search was conducted across PubMed, Ovid, Cochrane Library, and Web of Science.
- Studies comparing the 1-hour bundle and non-1-hour bundle in sepsis patients were included.
- The primary outcome measure was short-term mortality (in-hospital, 28-day, and 30-day).
Main Results:
- Ten studies involving 4435 patients were analyzed.
- The 1-hour bundle group had a lower overall mortality rate (20.8%) compared to the non-1-hour bundle group (24.7%).
- Meta-analysis confirmed a significant reduction in short-term mortality with the 1-hour bundle (95% CI 0.69-0.84), particularly in ICU and prospective studies.
Conclusions:
- Adherence to the 1-hour sepsis bundle can decrease short-term mortality in sepsis patients, especially within ICU settings.
- Further high-quality randomized trials are necessary to confirm these findings, particularly for emergency department settings.
- Critical care providers, including nurses, should integrate the 1-hour bundle into standard sepsis care protocols to improve patient outcomes.
Objectives:
To conduct a systematic review and meta-analysis to compare the impact of the 1-h bundle and non-1-h bundle on clinical outcomes in patients with sepsis.
Methods:
PubMed, Ovid, Cochrane Library, and Web of Science were searched to identify studies comparing the 1-h and non-1-h bundles in sepsis patient. The search strategy was based on a combination of Medical Subject Heading terms and text words. The primary outcome was short-term mortality, including in-hospital, 28-day, and 30-day mortality.
Results:
Ten studies (nine observational, one randomized trial) with 4435 patients were included. Overall mortality rates were 20.8 % in the 1-h bundle group and 24.7 % in the non-1-h bundle group. The meta-analysis showed that the 1-h bundle significantly reduced short-term mortality (95 % confidence interval [CI] 0.69-0.84). This effect was consistent across single-center (95 % CI 0.67-0.84) and multicenter studies (95 % CI 0.65-0.95). The mortality benefit was also pronounced in prospective studies (95 % CI 0.61-0.86) and ICU settings (95% CI 0.63-0.80), but not in retrospective studies (95 % CI 0.63-1.02) or emergency department settings (95 % CI 0.71-1.05). The limited number of randomized trials resulted in low certainty of evidence.
Conclusions:
Compliance with the 1-h bundle has the potential to reduce short-term mortality in sepsis patients, particularly in ICU settings. High-quality trials are needed to further validate these findings, especially in emergency department settings.
Implications For Clinical Practice:
Based on this study, critical care providers, including nurses, should consider implementing the 1-h bundle as part of their standard care protocols for sepsis patients, especially in the ICU. This could lead to improved patient outcomes and reduced mortality. Nurses play a crucial role in the early recognition and management of sepsis, and their adherence to the 1-h bundle can significantly impact patient care.
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