Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives.

PURPOSE: Sepsis can lead to poor outcomes when treatment is delayed or inadequate. The purpose of this study was to evaluate outcomes after initiation of a hospital-wide sepsis alert program. MATERIALS AND METHODS: Retrospective review of patients ≥18years treated for sepsis. RESULTS: There were 3917 sepsis admissions: 1929 admissions before, and 1988 in the after phase. Mean age (57.3 vs. 57.1, p=0.94) and Charlson Comorbidity Scores (2.52 vs. 2.47, p=0.35) were similar between groups. Multivariable analyses identified significant reductions in the after phase for odds of death (OR 0.62, 95% CI 0.39-0.99, p=0.046), mean intensive care unit LOS (2.12days before, 95%CI 1.97, 2.34; 1.95days after, 95%CI 1.75, 2.06; p<0.001), mean overall hospital LOS (11.7days before, 95% CI 10.9, 12.7days; 9.9days after, 95% CI 9.3, 10.6days, p<0.001), odds of mechanical ventilation use (OR 0.62, 95% CI 0.39, 0.99, p=0.007), and total charges with a savings of $7159 per sepsis admission (p=0.036). There was no reduction in vasopressor use (OR 0.89, 95% CI 0.75, 0.1.06, p=0.18). CONCLUSION: A hospital-wide program utilizing electronic recognition and RRT intervention resulted in improved outcomes in patients with sepsis.

Spatial distribution of polybrominated diphenyl ethers and polybrominated biphenyls in lake trout from the Laurentian Great Lakes.

Concentrations of two types of brominated flame-retardants (BFRs); polybrominated diphenyl ethers (PBDEs) and polybrominated biphenyls (PBBs) were determined in a single age class of lake trout (Salvelinus namaycush) collected from the Laurentian Great Lakes in 1997. Mean concentrations of total PBDE were highest in samples from Lake Ontario at 95+/-22 ng/g wet weight (ww) or 434+/-100 ng/g lipid weight (lw) while the lowest concentrations were observed in Lake Erie lake trout (27+/-8.6 ng/g ww, 117+/-37 ng/g lw). In all samples, the predominant PBDE congeners were 2,2',4,4'-tetrabromodiphenyl ether (BDE-47), 2,2',4,4',5-pentabromodiphenyl ether (BDE-99), and 2,2',4,4', 6-pentabromodiphenyl ether (BDE-100), which are the primary components of the commonly used penta-BDE formulation flame retardant. Lake trout collected from Lake Huron had the highest concentrations of PBBs (3.1+/-1.7 ng/g ww, 15+/-8.5 ng/g lw), while the lowest levels were detected in fish from Lake Superior (0.25+/-0.13 ng/g ww, 1.7+/-0.89 ng/g lw). In all lake trout samples, 2,2',4,4',5,5'-hexabromobiphenyl (BB-153), a major constituent of the flame-retardant FireMaster BP-6, was the predominant PBB congener.