Improving mortality in sepsis: analysis of clinical trials.

Sepsis accounts for a huge number of deaths in intensive care units worldwide. Encouraging data from recent studies show that some interventions are able to reverse such a picture. Surviving Sepsis Campaign (SSC) bundles were built based on these interventions. Many studies were published analyzing the impact of sepsis protocol implementation on compliance, costs, and mortality, and the results are herein analyzed. Based on these studies, it is not clear if the reduction is secondary to improvement in the quality of care naturally associated with protocol implementation or to the improvement in compliance to strict goals. A high heterogeneity is present among institutions and countries, and the pitfalls for protocol implementation seem to depend on local characteristics. In the same way, the impact of interventions might be different according to each institution's epidemiological profile. Interventions not impacting in low-mortality-rate institutions can be important for places where mortality is high. In Brazil, mortality rates are very high, and the results of Brazilian SSC network are presented and discussed.