Damiani Elisa, Donati Abele, Serafini Giulia, Rinaldi Laura, Adrario Erica, Pelaia Paolo, Busani Stefano, Girardis Massimo
Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Via Tronto 10, 60126 Torrette di Ancona, Italy.
Department of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100 Modena, Italy.
PLoS One. 2015 May 6;10(5):e0125827. doi: 10.1371/journal.pone.0125827. eCollection 2015.
Several reports suggest that implementation of the Surviving Sepsis Campaign (SSC) guidelines is associated with mortality reduction in sepsis. However, adherence to the guideline-based resuscitation and management sepsis bundles is still poor.
To perform a systematic review of studies evaluating the impact of performance improvement programs on compliance with Surviving Sepsis Campaign (SSC) guideline-based bundles and/or mortality.
Medline (PubMed), Scopus and Intercollegiate Studies Institute Web of Knowledge databases from 2004 (first publication of the SSC guidelines) to October 2014.
Studies on adult patients with sepsis, severe sepsis or septic shock that evaluated changes in compliance to individual/combined bundle targets and/or mortality following the implementation of performance improvement programs. Interventions may consist of educational programs, process changes or both.
Data from the included studies were extracted independently by two authors. Unadjusted binary data were collected in order to calculate odds ratios (OR) for compliance to individual/combined bundle targets. Adjusted (if available) or unadjusted data of mortality were collected. Random-effects models were used for the data synthesis.
Fifty observational studies were selected. Despite high inconsistency across studies, performance improvement programs were associated with increased compliance with the complete 6-hour bundle (OR = 4.12 [95% confidence interval 2.95-5.76], I(2) = 87.72%, k = 25, N = 50,081) and the complete 24-hour bundle (OR = 2.57 [1.74-3.77], I(2) = 85.22%, k = 11, N = 45,846) and with a reduction in mortality (OR = 0.66 [0.61-0.72], I(2) = 87.93%, k = 48, N = 434,447). Funnel plots showed asymmetry.
Performance improvement programs are associated with increased adherence to resuscitation and management sepsis bundles and with reduced mortality in patients with sepsis, severe sepsis or septic shock.
多项报告表明，实施拯救脓毒症运动（SSC）指南与降低脓毒症死亡率相关。然而，对基于指南的脓毒症复苏和管理集束治疗的依从性仍然较差。
对评估绩效改进计划对遵循拯救脓毒症运动（SSC）指南集束治疗和/或死亡率影响的研究进行系统评价。
2004年（SSC指南首次发表）至2014年10月的Medline（PubMed）、Scopus和大学间研究协会知识网络数据库。
关于脓毒症、严重脓毒症或脓毒性休克成年患者的研究，这些研究评估了实施绩效改进计划后对单个/联合集束治疗目标的依从性变化和/或死亡率。干预措施可能包括教育计划、流程改变或两者兼有。
纳入研究的数据由两位作者独立提取。收集未调整的二元数据，以便计算对单个/联合集束治疗目标的依从性的比值比（OR）。收集调整后（如有）或未调整的死亡率数据。采用随机效应模型进行数据合成。
选择了50项观察性研究。尽管各研究之间存在高度不一致性，但绩效改进计划与对完整6小时集束治疗的依从性增加相关（OR = 4.12 [95%置信区间2.95 - 5.76]，I(2) = 87.72%，k = 25，N = 50,081）以及与完整24小时集束治疗的依从性增加相关（OR = 2.57 [1.74 - 3.77]，I(2) = 85.22%，k = 11，N = 45,846），并且与死亡率降低相关（OR = 0.66 [0.61 - 0.72]，I(2) = 87.93%，k = 48，N = 434,447）。漏斗图显示不对称。
绩效改进计划与脓毒症、严重脓毒症或脓毒性休克患者对复苏和管理脓毒症集束治疗的依从性增加以及死亡率降低相关。
