Wang Lu, Ma Xudong, He Huaiwu, Su Longxiang, Guo Yanhong, Shan Guangliang, Wang Ye, Zhou Xiang, Liu Dawei, Long Yun
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, China.
Ann Transl Med. 2021 Feb;9(4):278. doi: 10.21037/atm-20-5429.
Effective implementation of the Surviving Sepsis Campaign (SSC) guidelines has effectively reduced sepsis mortality. The effects of hospital level and ownership on compliance with the SSC guideline 1-hour bundle (C) are unclear. We designed this study to identify the differences in C between secondary and tertiary hospitals, public hospitals, and private hospitals.
In this survey, 1,420 hospitals were enrolled, including 864 public tertiary hospitals, 482 public secondary hospitals, 34 private tertiary hospitals, 40 private secondary hospitals. The data were collected between January 1, 2018, and December 31, 2018. The outcomes were adherence to the SSC guidelines (2018 update). Monitoring indicators include 1-hour bundle and its sub-indicators (measure lactate level and remeasure lactate level if initial lactate is >2 mmol/L, obtain blood cultures before administering antibiotics, administer broad-spectrum antibiotics, begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, apply vasopressor if hypotension is present during or after fluid resuscitation to maintain a mean arterial pressure ≥65 mmHg). Every monitoring indicator was stratified by the median, which is defined as 1 if greater than or equal to the median, and 0 if not.
C in tertiary hospitals was significantly higher than in secondary hospitals (P0.05). However, there were no statistical differences in C in public hospitals and private hospitals.
C in tertiary hospitals was significantly better than that in secondary hospitals. There is an urgent need to improve C in secondary hospitals. The increase in private hospitals will not reduce C.
脓毒症存活行动（SSC）指南的有效实施已有效降低了脓毒症死亡率。医院级别和所有制对SSC指南1小时集束化治疗（C）依从性的影响尚不清楚。我们设计了本研究以确定二级医院与三级医院、公立医院与私立医院在C方面的差异。
在本次调查中，纳入了1420家医院，包括864家公立三级医院、482家公立二级医院、34家私立三级医院、40家私立二级医院。数据收集于2018年1月1日至2018年12月31日期间。结局指标为对SSC指南（2018年更新版）的依从性。监测指标包括1小时集束化治疗及其子指标（测量乳酸水平，若初始乳酸水平>2 mmol/L则重新测量乳酸水平，在使用抗生素前采集血培养标本，给予广谱抗生素，对于低血压或乳酸水平≥4 mmol/L开始快速输注30 mL/kg晶体液，若在液体复苏期间或之后出现低血压则应用血管活性药物以维持平均动脉压≥65 mmHg）。每个监测指标按中位数分层，若大于或等于中位数则定义为1，否则定义为0。
三级医院的C显著高于二级医院（P0.05）。然而，公立医院和私立医院在C方面无统计学差异。
三级医院的C显著优于二级医院。二级医院迫切需要提高C。私立医院数量的增加不会降低C。
