Intensive Care Medicine Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Crit Care Med. 2010 Apr;38(4):1036-43. doi: 10.1097/CCM.0b013e3181d455b6.
To describe the effectiveness of the Surviving Sepsis Campaign bundles with regard to both implementation and outcome in patients with septic shock and to determine the contribution of the various elements of the bundles to the outcome.
Quasi-experimental study with a historical comparison group.
The three medical-surgical intensive care units of an academic tertiary care center.
A total of 384 adult patients in septic shock were enrolled after the educational intervention (September 2005-August 2008) and 96 patients in the historical group (June 2004-May 2005).
A hospital-wide quality improvement program based on the implementation of the Surviving Sepsis Campaign guidelines performed between June 2005 and August 2005.
In-hospital mortality was reduced from 57.3% in the historical group to 37.5% in the intervention group (p = .001). This difference remained significant after controlling for confounding factors (odds ratio, 0.50; 95% confidence interval, 0.28-0.89). The intervention group had also lower length of stay for survivors in the hospital (36.2 +/- 34.8 days vs. 41.0 +/- 26.3 days; p = .043) and in the intensive care units (8.4 +/- 9.8 days vs. 11.0 +/- 9.5 days; p = .004). Improvements in survival were related to the number of bundle interventions completed (p for trend <.001). Compliance with six or more interventions of the 6-hr resuscitation bundle was an independent predictor of survival (adjusted odds ratio, 0.30; 95% confidence interval, 0.17-0.53; p <.001). The only single intervention with impact on mortality was the achievement of ScvO2 > or =70% (adjusted odds ratio, 0.62; 95% confidence interval, 0.38-0.99; p = .048).
The implementation of the Surviving Sepsis Campaign guidelines was associated with a significant decrease in mortality. The benefits depend on the number of interventions accomplished within the time limits. The 6-hr resuscitation bundle showed greater compliance and effectiveness than the 24-hr management bundle.
描述在感染性休克患者中，应用拯救脓毒症运动捆绑治疗方案在实施和结局方面的效果，并确定各捆绑治疗方案要素对结局的贡献。
准实验性研究，设有历史对照。
一所学术性三级医疗中心的 3 个内科-外科重症监护病房。
共纳入了 384 例感染性休克成年患者，这些患者在教育干预（2005 年 9 月至 2008 年 8 月）后入组，同时纳入了 96 例历史组患者（2004 年 6 月至 2005 年 5 月）。
2005 年 6 月至 2005 年 8 月，开展了一项基于拯救脓毒症运动指南实施的全院范围的质量改进计划。
与历史组（57.3%）相比，干预组的院内死亡率降低至 37.5%（p=0.001）。在校正混杂因素后，这种差异仍有统计学意义（比值比，0.50；95%置信区间，0.280.89）。在幸存者中，干预组的住院时间（36.2±34.8 天 vs. 41.0±26.3 天；p=0.043）和重症监护病房住院时间（8.4±9.8 天 vs. 11.0±9.5 天；p=0.004）也更短。生存的改善与捆绑治疗方案完成的干预次数相关（趋势检验 p<0.001）。完成 6 小时复苏捆绑治疗方案 6 项或更多干预的患者，其生存的独立预测因素（校正比值比，0.30；95%置信区间，0.170.53；p<0.001）。对死亡率有影响的唯一单个干预是实现中心静脉血氧饱和度（ScvO2）≥70%（校正比值比，0.62；95%置信区间，0.38~0.99；p=0.048）。
应用拯救脓毒症运动指南与死亡率的显著降低相关。获益取决于在时间限制内完成的干预次数。6 小时复苏捆绑治疗方案比 24 小时管理捆绑治疗方案具有更高的依从性和效果。
