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

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 associate...

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Published in:	BMJ Vol. 342; no. 7812; p. 1404
Main Authors:	Phua, Jason, Koh, Younsuck, Du, Bin, Tang, Yao-Qing, Divatia, Jigeeshu V, Tan, Cheng Cheng, Gomersall, Charles D, Faruq, Mohammad Omar, Shrestha, Babu Raja, Gia Binh, Nguyen, Arabi, Yaseen M, Salahuddin, Nawal, Wahyuprajitno, Bambang, Tu, Mei-Lien, Wahab, Ahmad Yazid Haji Abd, Hameed, Akmal A, Nishimura, Masaji, Procyshyn, Mark, Chan, Yiong Huak
Format:	Journal Article
Language:	English
Published:	England British Medical Journal Publishing Group 13-06-2011 BMJ Publishing Group BMJ Publishing Group LTD BMJ Publishing Group Ltd
Subjects:	Adult Intensive Care Antibiotics Asia Cohort analysis Cohort studies Data collection Emergency management Epidemiologic Studies Glucose Hospital units Hospitals Humans Hypertension Infectious Diseases Intensive care Intensive Care Units Mortality Nonprofit hospitals Ostomy Outcome Assessment (Health Care) Patients Pressure Prospective Studies Resuscitation Sepsis Sepsis - therapy Severity of Illness Index Ventilators Asia
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Summary:	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.
Bibliography:	ark:/67375/NVC-J1CHHLLT-4 href:bmj-342-bmj-d3245.pdf local:bmj;342/jun13_1/d3245 istex:523DCBD59CA3A647680222979840E14EA09F9B4D ArticleID:phuj839456 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0959-8138 1468-5833 1756-1833
DOI:	10.1136/bmj.d3245