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Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study.

Abstract：

OBJECTIVES:To assess the compliance of Asian intensive care units and hospitals to the Surviving Sepsis Campaign's resuscitation and management bundles. Secondary objectives were to evaluate the impact of compliance on mortality and the organisational characteristics of hospitals that were associated with higher compliance. DESIGN:Prospective cohort study. SETTING:150 intensive care units in 16 Asian countries. PARTICIPANTS:1285 adult patients with severe sepsis admitted to these intensive care units in July 2009. The organisational characteristics of participating centres, the patients' baseline characteristics, the achievement of targets within the resuscitation and management bundles, and outcome data were recorded. MAIN OUTCOME MEASURE:Compliance with the Surviving Sepsis Campaign's resuscitation (six hours) and management (24 hours) bundles. RESULTS:Hospital mortality was 44.5% (572/1285). Compliance rates for the resuscitation and management bundles were 7.6% (98/1285) and 3.5% (45/1285), respectively. On logistic regression analysis, compliance with the following bundle targets independently predicted decreased mortality: blood cultures (achieved in 803/1285; 62.5%, 95% confidence interval 59.8% to 65.1%), broad spectrum antibiotics (achieved in 821/1285; 63.9%, 61.3% to 66.5%), and central venous pressure (achieved in 345/870; 39.7%, 36.4% to 42.9%). High income countries, university hospitals, intensive care units with an accredited fellowship programme, and surgical intensive care units were more likely to be compliant with the resuscitation bundle. CONCLUSIONS:While mortality from severe sepsis is high, compliance with resuscitation and management bundles is generally poor in much of Asia. As the centres included in this study might not be fully representative, achievement rates reported might overestimate the true degree of compliance with recommended care and should be interpreted with caution. Achievement of targets for blood cultures, antibiotics, and central venous pressure was independently associated with improved survival.

journal_name

BMJ

journal_title

BMJ (Clinical research ed.)

authors

Phua J,Koh Y,Du B,Tang YQ,Divatia JV,Tan CC,Gomersall CD,Faruq MO,Shrestha BR,Gia Binh N,Arabi YM,Salahuddin N,Wahyuprajitno B,Tu ML,Wahab AY,Hameed AA,Nishimura M,Procyshyn M,Chan YH,MOSAICS Study Group.

doi

10.1136/bmj.d3245

subject

Has Abstract

pub_date

2011-06-13 00:00:00

pages

d3245

eissn

0959-8138

issn

1756-1833

journal_volume

342

pub_type

杂志文章

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Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study.