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 RhodesEmail author
  • 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



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.


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


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)).


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.


Sepsis Quality improvement Surviving Sepsis Campaign Bundle 



Eduardo Romay for providing help and assistance with the E-CRF. The SSC, the ESICM and the SCCM provided logistic support for mailings, the website, and meetings of the steering committee. Centres did not receive any payment for recruiting patients.

Conflicts of interest

AR, JDC, DdB, ML, LE and RF have all held leadership positions in the Surviving Sepsis Campaign. No other conflicts of interest have been declared as relevant to this paper.

Supplementary material

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


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Andrew Rhodes
    • 1
    Email author
  • 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

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