Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina.
Clinical Pharmacy, University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
Microb Drug Resist. 2021 Sep;27(9):1203-1206. doi: 10.1089/mdr.2020.0454. Epub 2021 Mar 19.
Treatment of sepsis and septic shock can be a challenge even for intensive care units (ICUs) in high income countries, but it is especially difficult for ICUs with limited resources. To evaluate the impact of CERTAIN on treatment of critically ill septic patients in low-resource medical ICU. In a before-and-after study design, we compared clinical outcomes, processes, and complications (hospital acquired infections) 1 year before and 2 years after (2016 and 2017) introduction of CERTAIN. A total of 125 patients with sepsis were prospectively identified for a 3-year period. Mean patient age, gender distribution, number of patients on mechanical ventilation (33 [76.7%] vs. 42 [84%] vs. 24 [75%]) and vasopressor use (23 [53.5%] vs. 34 [68%] vs. 24 [75%]) were similar before (2015) and 2 years after (2016 and 2017) the implementation of CERTAIN. Severity of illness (Simplified Acute Physiology Score II [SAPS II score]) was higher after the implementation. The checklist was incorporated in the daily practice with 100% adherence to its use. The duration of mechanical ventilation (5.3 ± 5.3 vs. 4.2 ± 3.6 vs. 3.7 ± 5.5), antibiotic treatment (8.2 ± 5.4 vs. 6.9 ± 4.1 vs. 5.8 ± 5.6), central venous catheter use (6.2 ± 5.7 vs. 5.7 ± 4.6 vs. 4.2 ± 6.1), ICU stay (8.4 ± 5.4 vs. 7.1 ± 4.1 vs. 5.8 ± 5.6), and the incidence of nosocomial infection (33.3% vs. 30% vs. 12.5%) decreased in the period after the onset of the intervention, but the results did not reach statistical significance. When adjusted for baseline characteristics, CERTAIN was not associated with hospital mortality (odds ratio 0.88, 0.38-2.04). CERTAIN was readily adopted in the ICU workflow and was associated with improvement in treatment of critically ill patients with sepsis.
即使是在高收入国家的重症监护病房（ICU），脓毒症和脓毒性休克的治疗也可能是一个挑战，但对于资源有限的 ICU 来说，治疗尤其困难。评估 CERTAIN 对资源有限的医疗 ICU 中危重症脓毒症患者治疗的影响。采用前后对照设计，比较 CERTAIN 引入前 1 年（2015 年）和引入后 2 年（2016 年和 2017 年）的临床结局、过程和并发症（医院获得性感染）。前瞻性确定了 125 例脓毒症患者，为期 3 年。患者年龄、性别分布、机械通气患者人数（33 [76.7%] vs. 42 [84%] vs. 24 [75%]）和血管加压素使用率（23 [53.5%] vs. 34 [68%] vs. 24 [75%]）在 CERTAIN 实施前（2015 年）和实施后 2 年（2016 年和 2017 年）相似。疾病严重程度（简化急性生理学评分 II [SAPS II 评分]）在实施后较高。该检查表已纳入日常实践，其使用的依从性达到 100%。机械通气时间（5.3±5.3 比 4.2±3.6 比 3.7±5.5）、抗生素治疗时间（8.2±5.4 比 6.9±4.1 比 5.8±5.6）、中心静脉导管使用时间（6.2±5.7 比 5.7±4.6 比 4.2±6.1）、入住 ICU 时间（8.4±5.4 比 7.1±4.1 比 5.8±5.6）和医院感染发生率（33.3%比 30%比 12.5%）在干预开始后下降，但结果未达到统计学意义。在校正基线特征后，CERTAIN 与医院死亡率无关（比值比 0.88，0.38-2.04）。 CERTAIN 很容易被 ICU 工作流程采用，并与改善脓毒症危重症患者的治疗相关。
