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The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study)

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Abstract

Introduction

Despite evidence demonstrating the value of performance initiatives, marked differences remain between hospitals in the delivery of care for patients with sepsis. The aims of this study were to improve our understanding of how compliance with the 3-h and 6-h Surviving Sepsis Campaign (SSC) bundles are used in different geographic areas, and how this relates to outcome.

Methods

This was a global, prospective, observational, quality improvement study of compliance with the SSC bundles in patients with either severe sepsis or septic shock.

Results

A total of 1794 patients from 62 countries were enrolled in the study with either severe sepsis or septic shock. Overall compliance with all the 3-h bundle metrics was 19 %. This was associated with lower hospital mortality than non-compliance (20 vs. 31 %, p < 0.001). Overall compliance with all the 6-h bundle metrics was 36 %. This was associated with lower hospital mortality than non-compliance (22 vs. 32 %, p < 0.001). After adjusting the crude mortality differences for ICU admission, sepsis status (severe sepsis or septic shock), location of diagnosis, APACHE II score and country, compliance remained independently associated with improvements in hospital mortality for both the 3-h bundle (OR = 0.64 (95 % CI 0.47−0.87), p = 0.004)) and 6-h bundle (OR = 0.71 (95 % CI 0.56−0.90), p = 0.005)).

Discussion

Compliance with all of the evidence-based bundle metrics was not high. Patients whose care included compliance with all of these metrics had a 40 % reduction in the odds of dying in hospital with the 3-h bundle and 36 % for the 6-h bundle.

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References

  1. Angus DC, van der Poll T (2013) Severe sepsis and septic shock. N Eng J Med 369:840–851

    Article  CAS  Google Scholar 

  2. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R (2014) Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 311:1308–1316

    Article  CAS  PubMed  Google Scholar 

  3. Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, Osborn T, Lemeshow S, Chiche JD, Artigas A, Dellinger RP (2015) Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med 43:3–12

    Article  PubMed  Google Scholar 

  4. Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, Osborn T, Lemeshow S, Chiche JD, Artigas A, Dellinger RP (2014) Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Intensive Care Med 40:1623–1633

    Article  PubMed  Google Scholar 

  5. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 30:536–555

    Article  PubMed  Google Scholar 

  6. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 34:17–60

    Article  PubMed Central  PubMed  Google Scholar 

  7. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228

    Article  CAS  PubMed  Google Scholar 

  8. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, Schorr C, Artigas A, Ramsay G, Beale R, Parker MM, Gerlach H, Reinhart K, Silva E, Harvey M, Regan S, Angus DC, Surviving Sepsis Campain (2010) The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med 38:367–374

    Article  PubMed  Google Scholar 

  9. Levy MM, Pronovost PJ, Dellinger RP, Townsend S, Resar RK, Clemmer TP, Ramsay G (2004) Sepsis change bundles: converting guidelines into meaningful change in behavior and clinical outcome. Crit Care Med 32:S595–S597

    Article  PubMed  Google Scholar 

  10. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31:1250–1256

    Article  PubMed  Google Scholar 

  11. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533

    PubMed  Google Scholar 

  12. Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ (2014) Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med 42:625–631

    Article  PubMed Central  PubMed  Google Scholar 

  13. Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P (2014) Goal-directed resuscitation for patients with early septic shock. N Eng J Med 371:1496–1506

    Article  CAS  Google Scholar 

  14. Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC (2014) A randomized trial of protocol-based care for early septic shock. N Eng J Med 370:1683–1693

    Article  CAS  Google Scholar 

  15. 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 (2011) Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. BMJ 342:d3245

    Article  PubMed Central  PubMed  Google Scholar 

  16. Ranieri VM, Thompson BT, Barie PS, Dhainaut JF, Douglas IS, Finfer S, Gardlund B, Marshall JC, Rhodes A, Artigas A, Payen D, Tenhunen J, Al-Khalidi HR, Thompson V, Janes J, Macias WL, Vangerow B, Williams MD (2012) Drotrecogin alfa (activated) in adults with septic shock. N Eng J Med 366:2055–2064

    Article  CAS  Google Scholar 

  17. Levy MM, Artigas A, Phillips GS, Rhodes A, Beale R, Osborn T, Vincent JL, Townsend S, Lemeshow S, Dellinger RP (2012) Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infect Dis 12:919–924

    Article  PubMed  Google Scholar 

  18. Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP (2012) The variability of critical care bed numbers in Europe. Intensive Care Med 38:1647–1653

    Article  CAS  PubMed  Google Scholar 

  19. Rhodes A, Moreno RP (2012) Intensive care provision: a global problem. Rev Bras Ter Intensiva 24:322–325

    Article  PubMed Central  PubMed  Google Scholar 

  20. Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EA, de Keizer NF, Kersten A, Linde-Zwirble WT, Sandiumenge A, Rowan KM (2008) Variation in critical care services across North America and Western Europe. Crit Care Med 36(2787–2793):e2781–e2789

    Google Scholar 

  21. Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM (2011) Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med 183:1666–1673

    Article  PubMed  Google Scholar 

  22. Wunsch H, Linde-Zwirble WT, Harrison DA, Barnato AE, Rowan KM, Angus DC (2009) Use of intensive care services during terminal hospitalizations in England and the United States. Am J Respir Crit Care Med 180:875–880

    Article  PubMed  Google Scholar 

  23. Arabi Y, Alamry A, Levy MM, Taher S, Marini AM (2014) Improving the care of sepsis: between system redesign and professional responsibility: a roundtable discussion in the world sepsis day, September 25, 2013, Riyadh, Saudi Arabia. Ann Thorac Med 9:134–137

    Article  PubMed Central  PubMed  Google Scholar 

  24. Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR, Osborn TM, Reinhart K, Selvakumar N, Levy MM (2015) Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med 43:567–573

    Article  CAS  PubMed  Google Scholar 

  25. Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP, Artigas A, Schorr C, Levy MM (2014) Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 42:1749–1755

    Article  CAS  PubMed  Google Scholar 

  26. Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM (2015) Trial of early, goal-directed resuscitation for septic shock. N Eng J Med 372:1301–1311

    Article  CAS  Google Scholar 

  27. van Zanten AR, Brinkman S, Arbous MS, Abu-Hanna A, Levy MM, de Keizer NF (2014) Guideline bundles adherence and mortality in severe sepsis and septic shock. Crit Care Med 42:1890–1898

    Article  PubMed  Google Scholar 

  28. Pestana D, Espinosa E, Sangueesa-Molina JR, Ramos R, Perez-Fernandez E, Duque M, Martinez-Casanova E, Grp RSS (2010) Compliance with a sepsis bundle and its effect on intensive care unit mortality in surgical septic shock patients. J Trauma Inj Infect Crit Care 69:1282–1287

    Article  Google Scholar 

  29. Barochia AV, Cui X, Vitberg D, Suffredini AF, O’Grady NP, Banks SM, Minneci P, Kern SJ, Danner RL, Natanson C, Eichacker PQ (2010) Bundled care for septic shock: an analysis of clinical trials. Crit Care Med 38:668–678

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

Eduardo Romay for providing help and assistance with the E-CRF. The SSC, the ESICM and the SCCM provided logistic support for mailings, the website, and meetings of the steering committee. Centres did not receive any payment for recruiting patients.

Conflicts of interest

AR, JDC, DdB, ML, LE and RF have all held leadership positions in the Surviving Sepsis Campaign. No other conflicts of interest have been declared as relevant to this paper.

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Correspondence to Andrew Rhodes.

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Rhodes, A., Phillips, G., Beale, R. et al. The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Med 41, 1620–1628 (2015). https://doi.org/10.1007/s00134-015-3906-y

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