Semler Matthew W, Weavind Liza, Hooper Michael H, Rice Todd W, Gowda Supriya Srinivasa, Nadas Andras, Song Yanna, Martin Jason B, Bernard Gordon R, Wheeler Arthur P
1Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN. 2Division of Anesthesiology Critical Care Medicine, Vanderbilt University, Nashville, TN. 3Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA. 4Division of Critical Care, Christian Medical College Hospital, Vellore, Tamil Nadu, India. 5Institute for Software Integrated Systems, Vanderbilt University School of Engineering, Nashville, TN. 6Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN. 7Department of Internal Medicine, Meharry Medical College, Nashville, TN.
Crit Care Med. 2015 Aug;43(8):1595-602. doi: 10.1097/CCM.0000000000001020.
To determine whether addition of an electronic sepsis evaluation and management tool to electronic sepsis alerting improves compliance with treatment guidelines and clinical outcomes in septic ICU patients.
A pragmatic randomized trial.
Medical and surgical ICUs of an academic, tertiary care medical center.
Four hundred and seven patients admitted during a 4-month period to the medical or surgical ICU with a diagnosis of sepsis established at the time of admission or in response to an electronic sepsis alert.
Patients were randomized to usual care or the availability of an electronic tool capable of importing, synthesizing, and displaying sepsis-related data from the medical record, using logic rules to offer individualized evaluations of sepsis severity and response to therapy, informing users about evidence-based guidelines, and facilitating rapid order entry.
There was no difference between the electronic tool (218 patients) and usual care (189 patients) with regard to the primary outcome of time to completion of all indicated Surviving Sepsis Campaign 6-hour Sepsis Resuscitation Bundle elements (hazard ratio, 1.98; 95% CI, 0.75-5.20; p = 0.159) or time to completion of each element individually. ICU mortality, ICU-free days, and ventilator-free days did not differ between intervention and control. Providers used the tool to enter orders in only 28% of available cases.
A comprehensive electronic sepsis evaluation and management tool is feasible and safe but did not influence guideline compliance or clinical outcomes, perhaps due to low utilization.
确定在电子脓毒症警报基础上增加电子脓毒症评估与管理工具是否能提高脓毒症重症监护病房（ICU）患者对治疗指南的依从性及改善临床结局。
一项实用的随机试验。
一所学术性三级医疗中心的内科和外科重症监护病房。
在4个月期间入住内科或外科ICU的407例患者，这些患者在入院时或因电子脓毒症警报而被诊断为脓毒症。
患者被随机分为接受常规治疗或使用一种电子工具，该工具能够从病历中导入、综合并显示脓毒症相关数据，运用逻辑规则对脓毒症严重程度及治疗反应进行个体化评估，向用户告知循证指南，并促进快速医嘱录入。
在完成所有指定的“拯救脓毒症运动”6小时脓毒症复苏集束要素的时间这一主要结局方面，电子工具组（218例患者）和常规治疗组（189例患者）之间无差异（风险比，1.98；95%置信区间，0.75 - 5.20；p = 0.159），各个要素完成时间方面也无差异。干预组和对照组在ICU死亡率、无ICU天数和无呼吸机天数方面无差异。在仅28%的可用病例中，医护人员使用该工具录入医嘱。
一种综合性电子脓毒症评估与管理工具是可行且安全的，但未影响指南依从性或临床结局，可能是由于使用率较低。
