Arabi Yaseen M, Al-Dorzi Hasan M, Alamry Ahmed, Hijazi Ra'ed, Alsolamy Sami, Al Salamah Majid, Tamim Hani M, Al-Qahtani Saad, Al-Dawood Abdulaziz, Marini Abdellatif M, Al Ehnidi Fatimah H, Mundekkadan Shihab, Matroud Amal, Mohamed Mohamed S, Taher Saadi
Intensive Care Department, MC-1425, Respiratory Services, College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
Ann Intensive Care. 2017 Dec;7(1):57. doi: 10.1186/s13613-017-0280-7. Epub 2017 May 30.
Compliance with the clinical practice guidelines of sepsis management has been low. The objective of our study was to describe the results of implementing a multifaceted intervention including an electronic alert (e-alert) with a sepsis response team (SRT) on the outcome of patients with sepsis and septic shock presenting to the emergency department.
This was a pre-post two-phased implementation study that consisted of a pre-intervention phase (January 01, 2011-September 24, 2012), intervention phase I (multifaceted intervention including e-alert, from September 25, 2012-March 03, 2013) and intervention phase II when SRT was added (March 04, 2013-October 30, 2013) in a 900-bed tertiary-care academic hospital. We recorded baseline characteristics and processes of care in adult patients presenting with sepsis or septic shock. The primary outcome measures were hospital mortality. Secondary outcomes were the need for mechanical ventilation and length of stay in the intensive unit and in the hospital.
After implementing the multifaceted intervention including e-alert and SRT, cases were identified with less severe clinical and laboratory abnormalities and the processes of care improved. When adjusted to propensity score, the interventions were associated with reduction in hospital mortality [for intervention phase II compared to pre-intervention: adjusted odds ratio (aOR) 0.71, 95% CI 0.58-0.85, p = 0.003], reduction in the need for mechanical ventilation (aOR 0.45, 95% CI 0.37-0.55, p < 0.0001) and reduction in ICU LOS and hospital LOS for all patients as well as ICU LOS for survivors.
Implementing a multifaceted intervention including sepsis e-alert with SRT was associated with earlier identification of sepsis, increase in compliance with sepsis resuscitation bundle and reduction in the need for mechanical ventilation and reduction in hospital mortality and LOS.
脓毒症管理临床实践指南的依从性一直较低。我们研究的目的是描述实施包括电子警报（e-警报）和脓毒症反应团队（SRT）在内的多方面干预措施，对急诊科脓毒症和脓毒性休克患者结局的影响。
这是一项前后两阶段的实施性研究，在一家拥有900张床位的三级医疗学术医院进行，包括干预前阶段（2011年1月1日至2012年9月24日）、干预阶段I（包括e-警报的多方面干预，2012年9月25日至2013年3月3日）和增加SRT的干预阶段II（2013年3月4日至2013年10月30日）。我们记录了脓毒症或脓毒性休克成年患者的基线特征和护理过程。主要结局指标是医院死亡率。次要结局是机械通气需求、重症监护病房和医院的住院时间。
实施包括e-警报和SRT在内的多方面干预措施后，识别出的病例临床和实验室异常情况较轻，护理过程得到改善。在调整倾向评分后，干预措施与医院死亡率降低相关[与干预前相比，干预阶段II：调整后的优势比（aOR）为0.71，95%可信区间为0.58-0.85，p = 0.003]，机械通气需求降低（aOR为0.45，95%可信区间为0.37-0.55，p < 0.0001），所有患者的重症监护病房住院时间和医院住院时间以及幸存者的重症监护病房住院时间均缩短。
实施包括脓毒症e-警报和SRT在内的多方面干预措施与脓毒症的早期识别、脓毒症复苏集束的依从性增加、机械通气需求降低以及医院死亡率和住院时间缩短相关。
