A Comparative Study between Current Sepsis Care Management And that after Application of Sepsis Care-Bundle on Patient Outcome in the Intensive Care Unit of Suez Canal University Hospital

Background: Sepsis syndrome is a significant health care challenge with documented mortalities ranging from 23-46% depending on the phase of disease process assessed. There is a mounting proof that evidence-based interventions decrease sepsis-related mortality. The aim of care bundles is to ensure that patients have received recommended treatments on a consistent basis. Methods: This study was a comparative study between Current care management group: Patients admitted to the ICU of Suez Canal University Hospital during the period from Jan. 2011 to Dec. 2013 fulfilling the criteria of sepsis and has been managed with current ICU protocol. Sepsis care bundle group: Patients admitted to the ICU fulfilling the criteria of sepsis and managed with sepsis care bundle after its application. Results: Hospital mortality was decreased 45.66% from 53.48% in the current care group to 29.06% in the care bundle group. After implementation of care bundle, mean ICU length of stay was decreased from 8.03 to 7.58 days. Also after implementation of sepsis care bundle, mean hospital length of stay was decreased from 20.24 days in the current care group to 14.65 days in the care bundle group (p-value=0.000). After implementation of care bundle we achieved the 6- hour resuscitation bundle in 81.39% of patients in the care bundle group after it was achieved in only 3.48% in the current care group. As the compliance rate for achievement of sepsis care bundle components improved five times for patients done !5 components. The free-ventilation period was a possible confounder as it may be an independent predictor of adverse events (p-value 0.001) with adjusted OR 1.46. We found that regarding plasma Lactate measurement, blood culture taken before antibiotics, Fluid challenge 20ml/kg, achievement of mean arterial blood pressure (MABP) !65 mmHg, achievement of central venous pressure (CVP) 8 mmHg and achievement of central venous O2 saturation ScvO2 70%, there was a statistically significant difference between study groups. Discussion: Increased compliance and awareness to the implemented sepsis care bundle strategy suggests that the earlier goal directed therapy were delivered, the better the outcomes early diagnosis of sepsis by sepsis screening tool may increase the chance of early intervention. Using the plasma Lactate as one of the tools for diagnosis of sepsis may pick up patients impending septic shock before frank hypotension occurs. Conclusion: Implementation of sepsis care bundle reduced in-hospital mortality rate, ICU length of stay, hospital length of stay and ICU ventilation period.