A 10-Year Longitudinal Analysis of Protocol-Based Sepsis Management in a Philippine Tertiary ICU.
Crit Care Explor
; 1(11): e0056, 2019 Nov.
Article
en En
| MEDLINE
| ID: mdl-32166240
ABSTRACT
OBJECTIVES:
To compare the outcomes of sepsis management using protocol-based therapy versus non-protocolized care, assessed over 10 years.DESIGN:
Retrospective cohort study, analyzed longitudinally with risk-adjusted control charts, referenced against hospital- and unit-level programs or interventions.SETTING:
Private, tertiary teaching hospital ICU in the Philippines. PATIENTS Nine-hundred fifty adult patients (19 yr old or older) diagnosed with severe sepsis or septic shock, using 2001 consensus definitions, admitted to the ICU from September 2007 to August 2017.INTERVENTIONS:
Three iterations of a standard clinical pathway (including early antibiotics, prescribed fluid resuscitation, and hemodynamic management) versus concurrent non-protocolized care. MEASUREMENTS AND MAINRESULTS:
Seven-hundred sixty patients were in the protocol-based care group versus 190 in the non-protocolized care group. Protocol-based management was associated with lower hospital mortality (28.4% vs 44.7%; p = 0.00) and ICU mortality (24.2% vs 31.6%; p = 0.038). There were no differences in ICU or hospital length-of-stay, mechanical ventilator days, or vasoactive days. Risk-Adjusted Cumulative Sum and Risk-Adjusted Exponentially Weighted Moving Average control charts showed that a survival advantage was achieved after 1 year and was sustained over the duration of the study.CONCLUSIONS:
Protocol-based management was associated with sustained improvements in the survival of sepsis patients over 10 years in this hospital setting, after a run-in period of 1 year. Hospital- and unit-level interventions may have measurable impacts on the efficacy of sepsis clinical pathways.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Tipo de estudio:
Guideline
/
Observational_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Crit Care Explor
Año:
2019
Tipo del documento:
Article
País de afiliación:
Filipinas