Intensive Care Medicine

, Volume 41, Issue 9, pp 1620–1628 | Cite as

The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study)

  • Andrew Rhodes
  • Gary Phillips
  • Richard Beale
  • Maurizio Cecconi
  • Jean Daniel Chiche
  • Daniel De Backer
  • Jigeeshu Divatia
  • Bin Du
  • Laura Evans
  • Ricard Ferrer
  • Massimo Girardis
  • Despoina Koulenti
  • Flavia Machado
  • Steven Q. Simpson
  • Cheng Cheng Tan
  • Xavier Wittebole
  • Mitchell Levy
Original

Abstract

Introduction

Despite evidence demonstrating the value of performance initiatives, marked differences remain between hospitals in the delivery of care for patients with sepsis. The aims of this study were to improve our understanding of how compliance with the 3-h and 6-h Surviving Sepsis Campaign (SSC) bundles are used in different geographic areas, and how this relates to outcome.

Methods

This was a global, prospective, observational, quality improvement study of compliance with the SSC bundles in patients with either severe sepsis or septic shock.

Results

A total of 1794 patients from 62 countries were enrolled in the study with either severe sepsis or septic shock. Overall compliance with all the 3-h bundle metrics was 19 %. This was associated with lower hospital mortality than non-compliance (20 vs. 31 %, p < 0.001). Overall compliance with all the 6-h bundle metrics was 36 %. This was associated with lower hospital mortality than non-compliance (22 vs. 32 %, p < 0.001). After adjusting the crude mortality differences for ICU admission, sepsis status (severe sepsis or septic shock), location of diagnosis, APACHE II score and country, compliance remained independently associated with improvements in hospital mortality for both the 3-h bundle (OR = 0.64 (95 % CI 0.47−0.87), p = 0.004)) and 6-h bundle (OR = 0.71 (95 % CI 0.56−0.90), p = 0.005)).

Discussion

Compliance with all of the evidence-based bundle metrics was not high. Patients whose care included compliance with all of these metrics had a 40 % reduction in the odds of dying in hospital with the 3-h bundle and 36 % for the 6-h bundle.

Keywords

Sepsis Quality improvement Surviving Sepsis Campaign Bundle 

Supplementary material

134_2015_3906_MOESM1_ESM.docx (249 kb)
Supplementary material 1 (DOCX 249 kb)

References

  1. 1.
    Angus DC, van der Poll T (2013) Severe sepsis and septic shock. N Eng J Med 369:840–851CrossRefGoogle Scholar
  2. 2.
    Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R (2014) Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 311:1308–1316CrossRefPubMedGoogle Scholar
  3. 3.
    Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, Osborn T, Lemeshow S, Chiche JD, Artigas A, Dellinger RP (2015) Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med 43:3–12CrossRefPubMedGoogle Scholar
  4. 4.
    Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, Osborn T, Lemeshow S, Chiche JD, Artigas A, Dellinger RP (2014) Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Intensive Care Med 40:1623–1633CrossRefPubMedGoogle Scholar
  5. 5.
    Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 30:536–555CrossRefPubMedGoogle Scholar
  6. 6.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 34:17–60PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228CrossRefPubMedGoogle Scholar
  8. 8.
    Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, Schorr C, Artigas A, Ramsay G, Beale R, Parker MM, Gerlach H, Reinhart K, Silva E, Harvey M, Regan S, Angus DC, Surviving Sepsis Campain (2010) The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med 38:367–374CrossRefPubMedGoogle Scholar
  9. 9.
    Levy MM, Pronovost PJ, Dellinger RP, Townsend S, Resar RK, Clemmer TP, Ramsay G (2004) Sepsis change bundles: converting guidelines into meaningful change in behavior and clinical outcome. Crit Care Med 32:S595–S597CrossRefPubMedGoogle Scholar
  10. 10.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31:1250–1256CrossRefPubMedGoogle Scholar
  11. 11.
    Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533PubMedGoogle Scholar
  12. 12.
    Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ (2014) Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med 42:625–631PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P (2014) Goal-directed resuscitation for patients with early septic shock. N Eng J Med 371:1496–1506CrossRefGoogle Scholar
  14. 14.
    Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC (2014) A randomized trial of protocol-based care for early septic shock. N Eng J Med 370:1683–1693CrossRefGoogle Scholar
  15. 15.
    Phua J, Koh Y, Du B, Tang YQ, Divatia JV, Tan CC, Gomersall CD, Faruq MO, Shrestha BR, Gia Binh N, Arabi YM, Salahuddin N, Wahyuprajitno B, Tu ML, Wahab AY, Hameed AA, Nishimura M, Procyshyn M, Chan YH (2011) Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. BMJ 342:d3245PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Ranieri VM, Thompson BT, Barie PS, Dhainaut JF, Douglas IS, Finfer S, Gardlund B, Marshall JC, Rhodes A, Artigas A, Payen D, Tenhunen J, Al-Khalidi HR, Thompson V, Janes J, Macias WL, Vangerow B, Williams MD (2012) Drotrecogin alfa (activated) in adults with septic shock. N Eng J Med 366:2055–2064CrossRefGoogle Scholar
  17. 17.
    Levy MM, Artigas A, Phillips GS, Rhodes A, Beale R, Osborn T, Vincent JL, Townsend S, Lemeshow S, Dellinger RP (2012) Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infect Dis 12:919–924CrossRefPubMedGoogle Scholar
  18. 18.
    Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP (2012) The variability of critical care bed numbers in Europe. Intensive Care Med 38:1647–1653CrossRefPubMedGoogle Scholar
  19. 19.
    Rhodes A, Moreno RP (2012) Intensive care provision: a global problem. Rev Bras Ter Intensiva 24:322–325PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EA, de Keizer NF, Kersten A, Linde-Zwirble WT, Sandiumenge A, Rowan KM (2008) Variation in critical care services across North America and Western Europe. Crit Care Med 36(2787–2793):e2781–e2789Google Scholar
  21. 21.
    Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM (2011) Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med 183:1666–1673CrossRefPubMedGoogle Scholar
  22. 22.
    Wunsch H, Linde-Zwirble WT, Harrison DA, Barnato AE, Rowan KM, Angus DC (2009) Use of intensive care services during terminal hospitalizations in England and the United States. Am J Respir Crit Care Med 180:875–880CrossRefPubMedGoogle Scholar
  23. 23.
    Arabi Y, Alamry A, Levy MM, Taher S, Marini AM (2014) Improving the care of sepsis: between system redesign and professional responsibility: a roundtable discussion in the world sepsis day, September 25, 2013, Riyadh, Saudi Arabia. Ann Thorac Med 9:134–137PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR, Osborn TM, Reinhart K, Selvakumar N, Levy MM (2015) Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med 43:567–573CrossRefPubMedGoogle Scholar
  25. 25.
    Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP, Artigas A, Schorr C, Levy MM (2014) Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 42:1749–1755CrossRefPubMedGoogle Scholar
  26. 26.
    Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM (2015) Trial of early, goal-directed resuscitation for septic shock. N Eng J Med 372:1301–1311CrossRefGoogle Scholar
  27. 27.
    van Zanten AR, Brinkman S, Arbous MS, Abu-Hanna A, Levy MM, de Keizer NF (2014) Guideline bundles adherence and mortality in severe sepsis and septic shock. Crit Care Med 42:1890–1898CrossRefPubMedGoogle Scholar
  28. 28.
    Pestana D, Espinosa E, Sangueesa-Molina JR, Ramos R, Perez-Fernandez E, Duque M, Martinez-Casanova E, Grp RSS (2010) Compliance with a sepsis bundle and its effect on intensive care unit mortality in surgical septic shock patients. J Trauma Inj Infect Crit Care 69:1282–1287CrossRefGoogle Scholar
  29. 29.
    Barochia AV, Cui X, Vitberg D, Suffredini AF, O’Grady NP, Banks SM, Minneci P, Kern SJ, Danner RL, Natanson C, Eichacker PQ (2010) Bundled care for septic shock: an analysis of clinical trials. Crit Care Med 38:668–678PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Andrew Rhodes
    • 1
  • Gary Phillips
    • 2
  • Richard Beale
    • 3
  • Maurizio Cecconi
    • 4
  • Jean Daniel Chiche
    • 5
  • Daniel De Backer
    • 6
  • Jigeeshu Divatia
    • 7
  • Bin Du
    • 8
  • Laura Evans
    • 9
  • Ricard Ferrer
    • 10
    • 11
  • Massimo Girardis
    • 12
  • Despoina Koulenti
    • 13
    • 14
  • Flavia Machado
    • 15
  • Steven Q. Simpson
    • 16
  • Cheng Cheng Tan
    • 17
  • Xavier Wittebole
    • 18
  • Mitchell Levy
    • 19
  1. 1.Department of Intensive Care MedicineSt George’s University Hospitals NHS Foundation TrustLondonUK
  2. 2.The Ohio State University Center for BiostatisticsColumbusUSA
  3. 3.Department of Critical CareKing’s College London, Guy’s and St Thomas’ Foundation TrustLondonUK
  4. 4.St George’s University Hospitals NHS Foundation TrustLondonUK
  5. 5.Réanimation Médicale-Hôpital CochinParis Cedex 14France
  6. 6.Department of Intensive CareErasme University Hospital, Université Libre de BruxellesBrusselsBelgium
  7. 7.Department of AnaesthesiaCritical Care & Pain Tata Memorial HospitalMumbaiIndia
  8. 8.Medical ICUPeking Union Medical College HospitalBeijingChina
  9. 9.Critical Care DepartmentNYU School of Medicine, Bellevue Hospital CenterNew YorkUSA
  10. 10.Intensive Care DepartmentHospital Universitari Mútua TerrassaBarcelonaSpain
  11. 11.CIBER Enfermedades RespiratoriasBarcelonaSpain
  12. 12.Department of Anesthesiology and Intensive Care UnitUniversity of ModenaModenaItaly
  13. 13.2nd Critical Care Department‘Attiko’ University HospitalAthensGreece
  14. 14.Burns, Trauma and Critical Care Research CentreThe University of QueenslandBrisbaneAustralia
  15. 15.Federal University of Sao PauloSao PauloBrazil
  16. 16.MICU, MTICU, MSICU Division of Pulmonary and Critical CareUniversity of KansasKansas CityUSA
  17. 17.ICUSultanah Aminah HospitalJohor BaruMalaysia
  18. 18.Critical Care DepartmentCliniques Universitaires St Luc, UCLBrusselsBelgium
  19. 19.Alpert Medical School at Brown University, Rhode Island HospitalProvidenceUSA

Personalised recommendations