Differences in compliance with Surviving Sepsis Campaign recommendations according to hospital entrance time: day versus night

作者：Almeida Monica^*; Ribeiro Orquidea; Aragao Irene; Costa Pereira Altamiro; Cardoso Teresa

来源：Critical Care, 2013, 17(2): R79.

DOI：10.1186/cc12689

• Surviving Sepsis Campaign (SSC)
• 6-hour bundle
• compliance rate
• hospital mortality

Introduction: Higher compliance with Surviving Sepsis Campaign (SSC) recommendations has been associated with lower mortality. The authors evaluate differences in compliance with SSC 6-hour bundle according to hospital entrance time (day versus night) and its impact on hospital mortality. %26lt;br%26gt;Methods: Prospective cohort study of all patients with community-acquired severe sepsis admitted to the intensive care unit of a large university tertiary care hospital, over 3.5 years with a follow-up until hospital discharge. Time to compliance with each recommendation of the SSC 6-hour bundle was calculated according to hospital entrance period: day (08:30 to 20:30) versus night (20:30 to 08:30). For the same periods, clinical staff composition and the number of patients attending the emergency department (ED) was also recorded. %26lt;br%26gt;Results: In this period 300 consecutive patients were included. Compliance rate was (night vs. day): serum lactate measurement 57% vs. 49% (P = 0.171), blood cultures drawn 59% vs. 37% (P %26lt; 0.001), antibiotics administration in the first 3 hours 33% vs. 18% (P = 0.003), central venous pressure %26gt; 8 mmHg 45% vs. 29% (P = 0.021), and central venous oxygen saturation (SvcO(2)) %26gt; 70%, 7% vs. 2% (P = 0.082); fluids were administered in all patients with hypotension in both periods and vasopressors were administered in patients with hypotension not responsive to fluids in 100% vs. 99%. Time to get specific actions done was also different (night vs. day): serum lactate measurement (4.5 vs. 7 h, P = 0.018), blood cultures drawn (4 vs. 8 h, P %26lt; 0.001), antibiotic administration (5 vs. 8 h, P %26lt; 0.001), central venous pressure (8 vs. 11 h, P = 0.01), and SvcO(2) monitoring (2.5 vs. 11 h, P = 0.222). The composition of the nursing team was the same around the clock; the medical team was reduced at night with a higher proportion of less differentiated doctors. The number of patients attending the Emergency Department was lower overnight. Hospital mortality rate was 34% in patients entering in the night period vs. 40% in those entering during the day (P = 0.281). %26lt;br%26gt;Conclusion: Compliance with SSC recommendations was higher at night. A possible explanation might be the increased nurse to patient ratio in that period. Adjustment of the clinical team composition to the patients%26apos; demand is needed to increase compliance and improve prognosis.

• 出版日期2013