Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America; Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
J Crit Care. 2020 Dec;60:143-151. doi: 10.1016/j.jcrc.2020.07.027. Epub 2020 Aug 7.
To assess the impact of the timeline of sepsis bundle completion with clinical outcomes in septic shock.
We retrospectively studied adult (≥18 years) patients with septic shock from January 1, 2006, through May 31, 2018, who were admitted to the intensive care unit in Mayo Clinic, Rochester. We divided patients into three groups based on the SSC compliant 1) <1h, 2) 1.1 to 3 h, 3) >3 h after the time of septic shock diagnosis.
We enrolled 1052 septic shock patients, among 8% were in group 1, 26% in group 2, and the remaining in group 3. Those who completed all bundle components within 3 h had the lowest 28-day mortality (17.5% vs. 31.4%, p < .001) and higher survival at 90 days (HR = 0.67; 95% CI 0.55-0.80; p < .001). Sepsis bundle completion in <1 h had no significant advantage in 28-day mortality (21.5% vs.15.9%, p = .4) or 90-day survival compared with group 2 (HR = 1.08; 95% CI 0.77-1.53; p = .6).
We showed an association between the completion of SSC bundle components within three hours with lower mortality or earlier shock reversal. This relationship was not evident when compared to bundle completion in 1 h vs. within 3 h.
评估脓毒症集束治疗完成时间与脓毒性休克临床结局的关系。
我们回顾性研究了 2006 年 1 月 1 日至 2018 年 5 月 31 日期间在梅奥诊所罗切斯特院区重症监护病房收治的成年（≥18 岁）脓毒性休克患者。我们根据 SSC 达标情况将患者分为三组：1）<1 小时，2）1.1-3 小时，3）>3 小时。
我们共纳入 1052 例脓毒性休克患者，其中 8%的患者在第 1 组，26%的患者在第 2 组，其余的患者在第 3 组。在 3 小时内完成所有集束治疗的患者 28 天死亡率最低（17.5% vs. 31.4%，p < 0.001），90 天生存率更高（HR=0.67；95%CI 0.55-0.80；p < 0.001）。在 1 小时内完成集束治疗与第 2 组相比，在 28 天死亡率（21.5% vs. 15.9%，p = 0.4）或 90 天生存率（HR=1.08；95%CI 0.77-1.53；p = 0.6）方面没有显著优势。
我们发现，在 3 小时内完成 SSC 集束治疗与死亡率降低或休克早期逆转有关。与 1 小时内完成集束治疗相比，在 3 小时内完成集束治疗与死亡率或休克早期逆转之间的关系并不明显。
