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

Authors
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; MOSAICS Study Group
Citation
British medical journal, 342:d3245-d3245, 2011
Journal Title
British medical journal
ISSN
0007-1447
Abstract
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.
MeSH terms
AsiaHumans*Intensive Care UnitsOutcome Assessment (Health Care)Prospective StudiesSepsis/*therapy*Severity of Illness Index
DOI
10.1136/bmj.d3245
PMID
21669950
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Journal Papers > School of Medicine / Graduate School of Medicine > Anesthesiology & Pain Medicine
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