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Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: a pilot study

机译：实施脓毒症计划对重症监护室和重症败血症和败血性休克患者的管理和结果的影响：一项试点研究

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IntroductionThe application in clinical practice of evidence-based guidelines for the management of patients with severe sepsis/septic shock is still poor in the emergency department, while little data are available for patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an in-hospital sepsis program on the adherence to evidence-based guidelines and outcome of patients with severe sepsis/septic shock admitted to the ICU.MethodsThis prospective observational cohort study included 67 patients with severe sepsis/septic shock admitted to a multidisciplinary ICU at a University Hospital from January 2005 to June 2007. Compliance to 5 resuscitation and 4 management sepsis interventions and in-hospital mortality were measured following an educational program on sepsis for physician and nurses of all hospital departments and hospital implementation of a specific protocol for recognition and management of patients with severe sepsis/septic shock, including an early consultation by a skilled 'sepsis team'.ResultsDuring the study period, the compliance to all 9 interventions increased from 8% to 35% of the patients (P < 0.01). The implementation of resuscitation and management interventions was associated with a lower risk of in-hospital mortality (23% vs 68% and 27% vs 68%, P < 0.01). In the latter 2 semesters, after activation of the 'sepsis team', in-hospital mortality of ICU septic shock patients decreased by about 40% compared with the previous period (32% vs 79%, P < 0.01).ConclusionsIn our experience, an in-hospital sepsis program, including education of health-care personnel and process-changes, improved the adherence to guidelines and the survival rate of patients with severe sepsis/septic shock admitted to the ICU.
机译：简介在急诊科中，临床上基于证据的指导方针用于治疗严重脓毒症/败血症性休克的患者仍然很少，而重症监护病房（ICU）的患者的数据很少。这项研究的目的是评估院内脓毒症方案对遵循循证指南和重症败血症/败血性休克患者入住ICU的效果。方法该前瞻性观察队列研究包括67例重症脓毒症患者。 2005年1月至2007年6月，在一家大学医院的多学科ICU中接受败血症/败血性休克。针对所有医院部门的医师和护士进行了关于败血症的教育计划，对5例复苏和4例脓毒症管理干预措施以及院内死亡率的依从性进行了测量以及医院实施特定方案以识别和管理严重败血症/败血性休克患者，包括由熟练的“败血症小组”进行早期咨询。结果在研究期间，所有9种干预措施的依从性从8％提高到35％的患者（P <0.01）。实施复苏和管理干预措施可降低院内死亡风险（23％比68％，27％比68％，P <0.01）。在后两个学期中，“败血症小组”启动后，ICU败血性休克患者的住院死亡率与上一时期相比下降了约40％（32％对79％，P <0.01）。院内败血症计划，包括对医护人员的教育和过程变更，提高了对重症监护病房/重症败血症/败血性休克患者入住ICU的指导性和生存率。

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