الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 134 |  |  |
| | | from | 134 | | |
Abstract
Sepsis syndrome is a significant health care challenge with documented mortalities ranging from 23-46% depending on the phase of disease process assessed.
There is a mounting proof that evidence-based interventions decrease sepsis-related mortality.
The bundle is a set of interventions (usually 3 to 5) when grouped and implemented together, improve outcomes with a greater impact than if performed, individually.
The aim of care bundles is to ensure that patients have received recommended treatments on a consistent basis.
This study was a comparative study between:
1. Current care management group: Patients admitted to the ICU of Suez Canal University Hospital fulfilling the criteria of sepsis and has been managed with current ICU protocol.
2. Sepsis care bundle group: Patients admitted to the ICU of Suez Canal University Hospital fulfilling the criteria of sepsis and has been managed with sepsis care bundle after its application.
We found that the overall in-hospital mortality was decreased 45.66% from 53.48% in the current care group to 29.06% in the care bundle group. This is explained by the full implementation of sepsis care bundle.
After implementation of care bundle, our mean ICU length of stay was decreased from 8.03 to 7.58 days. These results may be attributed to the improvement in early application of sepsis resuscitation care bundle.
Also after implementation of sepsis care bundle, our mean hospital length of stay was decreased from 20.24 days in the current care group to 14.65 days in the care bundle group (P value = 0.000). This significant difference between current care and care bundle groups may be attributed partly to the less degree of organ dysfunction in the care bundle group decreasing the total time spent in the hospital.
After implementation of care bundle we achieved the 6-hour resuscitation bundle in 81.39% of patients in the care bundle group after it was achieved in only 3.48% in the current care group. As the compliance rate for achievement of sepsis care bundle components improved five times for patients done ≥ 5 components.
We have evaluated the following potentially confounding variables in a logistic regression analysis: ICU length of stay, free-ventilation period and vasopressor. The free-ventilation period was a possible confounder because it may be an independent predictor of adverse events (P value < 0.001) with adjusted OR 1.46.
Regarding fluid therapy and packed Red Blood Cells (RBCs) administration given within 6 & 72 hours, there was a statistically significant difference only between current-care group and care-bundle group in fluid therapy given within 6 hours. This may reflect increased compliance to achieve fluid challenge 20 ml/kg, CVP 8-12 mmHg and MABP ≥ 65 mmHg as the care bundle say, insuring systemic perfusion and improving organ perfusion and function.
We found that regarding plasma Lactate measurement, blood culture taken before antibiotics, Fluid challenge 20ml/kg, achievement of mean arterial blood pressure (MABP) ≥ 65 mmHg, achievement of central venous pressure (CVP) > 8 mmHg and achievement of central venous O2 saturation ScvO2 >70%, there was a statistically significant difference between study groups.
There was also a statistically significant difference between current-care group and care-bundle groups regarding achievement of tight glucose control (RBS < 140mg / dl), achievement of Peak Airway Pressure (PAP) < 30 cmH2O and the mean of Peak Airway Pressure (PAP) after 24 hours of diagnosis.
Early diagnosis of sepsis by sepsis screening tool may increase the chance of early intervention for source eradication and antimicrobial administration.
Using the plasma Lactate as one of the tools for diagnosis of sepsis may pick up patients impending septic shock before frank hypotension occurs.