Anestéziológia a intenzívna medicína 1/2013

The impact of the implementation of the resuscitation bundle on mortality in septic patients

Objective: Severe sepsis and septic shock are major causes of morbidity and mortality in hospitalized ICU patients in noncoronary intensive care units. As the mortality rate of severe sepsis remains unacceptably high, a group of international expert developed guidelines in 2004, termed the Surviving Sepsis Campaign (SSC). The aim of the study was to determine the incidence of severe sepsis on I. KAIM and the rate of compliance with resuscitation bundle and the impact of compliance and other factors on the hospital mortality in patient with severe sepsis and septic shock. Materials and methods: During the years 2008–2011 we enrolled 198 septic patients with severe sepsis. Each patient had recorded of demographic, clinical, microbiological, and physiological data with the web database „Sepsa register“. We observed the rate of compliance with resuscitation bundle, 28 days mortality and risk factors of mortality. Results: Severe sepsis incidence during the study was 10.6% with 28 days mortality rate 55%. It was significantly lower APACHE II and SOFA score in the survival groups as the nonsurvival group (P < 0.001). The survival group had significantly better compliance of resuscitation bundle with survival benefit (OR – 1.973, CI – 1.068-3.646, P < 0.05). Number of failed organs was the strongest mortality predictor (OR 1.501, 95% CI 1.076-2.094). Conclusion: Incidence of severe sepsis in I. KAIM was 10.6%. Correct application of the resuscitation sepsis bundle was associated with reduced mortality. Total mortality remains high. High mortality in I. KAIM is associated with higher percentage of abdominal infection, higher incidence of septic shock and numbers of failing organs.

Keywords: severe sepsis, Surviving Sepsis Campaign, mortality.