Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
J Formos Med Assoc. 2012 Feb;111(2):77-82. doi: 10.1016/j.jfma.2011.01.004. Epub 2012 Feb 18.
BACKGROUND/PURPOSE: This two-part study aimed to investigate compliance with the sepsis resuscitation bundle (SRB) and the barriers to its implementation for patients developing septic shock in the general medical wards.
In the first part, medical records of patients who were admitted to the intensive care unit from the general medical wards due to septic shock were reviewed. Compliance rates with the six SRB components were assessed. In the second part, responsible junior physicians (first-year and second-year residents) in the general wards and senior physicians (third-year residents and fellows) were randomly invited for questionnaire-based interviews.
In the first part, during the 6-month study period, 40 patients were included. Overall compliance with the SRB within 6 h was only 2.5%, mainly due to femoral catheterization (42.5%) and the lack of measuring central venous oxygen saturation (ScvO₂). Delayed completion of SRB components contributed little to the low compliance rate. In the second part, based on the questionnaire results of 71 junior physicians and 64 senior physicians, the junior physicians were less familiar with the SRB guidelines, particularly regarding the meaning of ScvO₂ (p = 0.01) and management of low ScvO₂ (p = 0.04). Junior physicians were also more reluctant to measure the central venous pressure (CVP; p = 0.04) and the ScvO₂ (p = 0.01), and were also less confident with internal jugular vein or subclavian vein catheterization (p < 0.001).
Compliance with the SRB for patients developing septic shock in the general medical wards is very low. Besides providing educational programs to improve awareness and acceptance of the SRB, measures to help in central venous catheterization and completion of SRB may be considered.
背景/目的：本研究分为两部分，旨在调查普通内科病房发生感染性休克的患者对脓毒症复苏捆绑包（SRB）的依从性及其实施障碍。
在第一部分中，回顾了因感染性休克从普通内科病房转入重症监护病房的患者的病历。评估了 6 个 SRB 组成部分的依从率。在第二部分中，随机邀请普通病房的初级医生（一年级和二年级住院医师）和高级医生（三年级住院医师和研究员）进行基于问卷的访谈。
在第一部分，在 6 个月的研究期间，共纳入 40 名患者。SRB 在 6 小时内的总体依从率仅为 2.5%，主要是由于股静脉置管（42.5%）和缺乏测量中心静脉血氧饱和度（ScvO₂）所致。SRB 组成部分的延迟完成对低依从率的贡献不大。在第二部分，根据 71 名初级医生和 64 名高级医生的问卷调查结果，初级医生对 SRB 指南的了解较少，特别是关于 ScvO₂的含义（p=0.01）和低 ScvO₂的处理（p=0.04）。初级医生也更不愿意测量中心静脉压（CVP；p=0.04）和 ScvO₂（p=0.01），而且对颈内静脉或锁骨下静脉置管也不太有信心（p<0.001）。
普通内科病房发生感染性休克的患者对 SRB 的依从性非常低。除了提供教育计划以提高对 SRB 的认识和接受度外，还可以考虑采取措施帮助进行中心静脉置管和完成 SRB。
