OBJECTIVE: The Surviving Sepsis Campaign and Centers for Medicare and Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) recommend rapid crystalloid infusion (≥30 mL/kg) for patients with sepsis-induced hypoperfusion or septic shock. We aimed to assess compliance with this recommendation, factors associated with non-compliance, and how compliance relates to mortality. DESIGN: Retrospective, observational study. SETTING: 1136-bed academic and 235-bed community hospital (January 2015-June 2016). PATIENTS: Patients with septic shock. INTERVENTIONS: Crystalloid infusion (≥30 mL/kg) within 6 h of identification of septic shock as required by CMS. MEASUREMENTS: Associations with compliance and how compliance associates with mortality; odds ratios (OR) and 95% confidence intervals (CI) reported. MAIN RESULTS: Overall, 1027 septic shock patients were included. Of these, 486 (47.3%) met the 6-hour 30 ml/kg fluid requirement. Compliance was lower in patients with congestive heart failure (CHF) (40.9%), chronic kidney disease (CKD) (42.3%) or chronic liver disease (38.5%) and among those that were identified in the inpatient setting (35.4%) rather than in the emergency department (51.7%). When adjusting for relevant covariates, compliance (compared to non-compliance) was not associated with in-hospital mortality: OR 1.03 CI 0.76-1.41. CONCLUSIONS: These findings question a "one-size-fits-all" approach to fluid administration and performance measures for patients with sepsis.
OBJECTIVE: The Surviving Sepsis Campaign and Centers for Medicare and Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) recommend rapid crystalloid infusion (≥30 mL/kg) for patients with sepsis-induced hypoperfusion or septic shock. We aimed to assess compliance with this recommendation, factors associated with non-compliance, and how compliance relates to mortality. DESIGN: Retrospective, observational study. SETTING: 1136-bed academic and 235-bed community hospital (January 2015-June 2016). PATIENTS: Patients with septic shock. INTERVENTIONS: Crystalloid infusion (≥30 mL/kg) within 6 h of identification of septic shock as required by CMS. MEASUREMENTS: Associations with compliance and how compliance associates with mortality; odds ratios (OR) and 95% confidence intervals (CI) reported. MAIN RESULTS: Overall, 1027 septic shockpatients were included. Of these, 486 (47.3%) met the 6-hour 30 ml/kg fluid requirement. Compliance was lower in patients with congestive heart failure (CHF) (40.9%), chronic kidney disease (CKD) (42.3%) or chronic liver disease (38.5%) and among those that were identified in the inpatient setting (35.4%) rather than in the emergency department (51.7%). When adjusting for relevant covariates, compliance (compared to non-compliance) was not associated with in-hospital mortality: OR 1.03 CI 0.76-1.41. CONCLUSIONS: These findings question a "one-size-fits-all" approach to fluid administration and performance measures for patients with sepsis.
Authors: George L Anesi; Jayaram Chelluri; Zaffer A Qasim; Marzana Chowdhury; Rachel Kohn; Gary E Weissman; Brian Bayes; M Kit Delgado; Benjamin S Abella; Scott D Halpern; John C Greenwood Journal: Ann Am Thorac Soc Date: 2020-12
Authors: Andy Hung-Yi Lee; Emily Aaronson; Kathryn A Hibbert; Micah H Flynn; Hayley Rutkey; Elizabeth Mort; Jonathan D Sonis; Kyan C Safavi Journal: J Med Internet Res Date: 2021-06-24 Impact factor: 5.428
Authors: Arnaldo Dubin; Cecilia Loudet; Vanina S Kanoore Edul; Javier Osatnik; Fernando Ríos; Daniela Vásquez; Mario Pozo; Bernardo Lattanzio; Fernando Pálizas; Francisco Klein; Damián Piezny; Paolo N Rubatto Birri; Graciela Tuhay; Analía García; Analía Santamaría; Graciela Zakalik; Cecilia González; Elisa Estenssoro Journal: Ann Intensive Care Date: 2020-04-15 Impact factor: 6.925