Taj Mehrunnissa, Brenner Michael, Sulaiman Zeenat, Pandian Vinciya
Clinical Faculty, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, United States.
Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1540 E Hospital Drive, Ann Arbor, United States.
Intensive Crit Care Nurs. 2022 Oct;72:103255. doi: 10.1016/j.iccn.2022.103255. Epub 2022 Jun 7.
The management of sepsis in critically ill patients varies globally based on the availability of resources resulting in increased sepsis-related mortality rates in resource-restricted countries. We aimed to summarise evidence regarding components of sepsis protocols, compliance with implementing sepsis protocol, effects on lengths of stay and sepsis-related mortality, and facilitators and barriers to implementing sepsis protocols.
A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The quality was appraised using the Johns Hopkins Nursing Evidence-Based Practise model.
Six eligible studies reported using modified-sepsis protocols to recognise early warning signs of sepsis and manage sepsis in resource-restricted settings. Interventions comprised educational components and modified sepsis protocols (early sepsis screening tool and sepsis intervention bundle). Studies reported increased protocol compliance with education on and standardised sepsis protocols. While there was no significant impact on hospital lengths of stay, the sepsis-related mortality rates decreased by 22.6% even with partial implementation of the protocol. The primary challenge in implementing sepsis protocols in resource-restricted settings is the lack of resources necessary to complete every component of the protocol successfully.
Simplified sepsis protocols are essential to improving sepsis-related mortality rates in resource-restricted settings, but adequate training of clinicians and modified protocols are necessary for successful implementation.
由于资源可及性的差异，全球危重症患者脓毒症的管理方式各不相同，这导致资源有限国家的脓毒症相关死亡率上升。我们旨在总结脓毒症诊疗方案各组成部分的相关证据、实施脓毒症诊疗方案的依从性、对住院时间和脓毒症相关死亡率的影响，以及实施脓毒症诊疗方案的促进因素和障碍。
采用系统评价和Meta分析的首选报告项目进行系统评价。使用约翰霍普金斯基于循证实践的护理模式评估质量。
六项符合条件的研究报告了在资源有限的环境中使用改良的脓毒症诊疗方案来识别脓毒症的早期预警信号并管理脓毒症。干预措施包括教育内容和改良的脓毒症诊疗方案（早期脓毒症筛查工具和脓毒症干预集束）。研究报告称，通过对脓毒症诊疗方案进行教育和标准化，方案依从性有所提高。虽然对住院时间没有显著影响，但即使部分实施该方案，脓毒症相关死亡率仍下降了22.6%。在资源有限的环境中实施脓毒症诊疗方案的主要挑战是缺乏成功完成该方案每个组成部分所需的资源。
简化的脓毒症诊疗方案对于提高资源有限环境中的脓毒症相关死亡率至关重要，但临床医生的充分培训和改良的诊疗方案对于成功实施是必要的。
