Table 2.
Actions in Hospitals with Standardized Sepsis Management
| Action | Emergency Departments (n = 444) | Wards (n = 374) | ICUs (n = 589) |
|---|---|---|---|
| Surviving Sepsis campaign bundle | |||
| Measuring lactate level | 93.2% (90.5%–95.4%) | 81.6% (77.2%–85.4%) | 96.4% (94.6%–97.8%) |
| Obtaining blood cultures before administration of antibiotics | 97.3% (95.3%–98.6%) | 97.1% (94.8%–98.5%) | 98.0% (96.5%–98.9%) |
| Administering broad-spectrum antibiotics | 91.0% (87.9%–93.5%) | 93.6% (90.6%–95.8%) | 96.8% (95.0%–98.0%) |
| Beginning rapid administration of crystalloid* | 91.2% (88.2%–93.7%) | 88.8% (85.1%–91.8%) | 94.2% (92.0%–96.0%) |
| Applying vasopressors to maintain MAP ⩾65 mm Hg† | 81.8% (77.8%–85.2%) | 65.8% (60.7%–70.6%) | 96.9% (95.2%–98.2%) |
| Organ dysfunction | |||
| Blood testing‡ | 93.7% (91.0%–95.8%) | 91.4% (88.1%–94.1%) | 96.9% (95.2%–98.2%) |
| Catheterization/urine output measurement | 72.3% (67.9%–76.4%) | 74.3% (69.6%–78.7%) | 90.3% (87.6%–92.6%) |
| SOFA score | 55.4% (50.6%–60.1%) | 43.3% (38.2%–48.5%) | 77.8% (74.2%–81.1%) |
| Identification of source | |||
| Computed tomography | 38.1% (33.5%–42.8%) | 39.0% (34.1%–44.2%) | 50.1% (46.0%–54.2%) |
| Ultrasound | 51.4% (46.6%–56.1%) | 43.0% (38.0%–48.2%) | 57.9% (53.8%–61.9%) |
| Chest X-ray | 65.1% (60.5%–69.5%) | 59.4% (54.2%–64.4%) | 71.1% (67.3%–74.8%) |
| Additional microbiological sampling§ | 85.4% (81.7%–88.5%) | 85.8% (81.9%–89.2%) | 90.7% (88.0%–92.9%) |
| Source control | |||
| Initiation of rapid source control (surgical or interventional) | 57.4% (52.7%–62.1%) | 62.8% (57.7%–67.7%) | 70.6% (66.8%–74.3%) |
| Source control within 1–6 h | 33.8% (29.4%–38.4%) | 29.9% (25.3%–34.9%) | 40.2% (36.3%–44.3%) |
| Source control within 12 h | 12.2% (9.3%–15.6%) | 15.5% (12.0%–19.6%) | 15.6% (12.8%–18.8%) |
| Source control within 24 h | 2.5% (1.2%–4.4%) | 4.8% (2.9%–7.5%) | 3.9% (2.5%–5.8%) |
| No time frame | 1.6% (0.6%–3.2%) | 2.7% (1.3%–4.9%) | 2.0% (1.1%–3.5%) |
| Not specified | 7.4% (5.2%–10.3%) | 9.9% (7.1%–13.4%) | 8.8% (6.7%–11.4%) |
| Monitoring | |||
| Central venous catheter | 33.1% (28.7%–37.7%) | 36.9% (32.0%–42.0%) | 78.4% (74.9%–81.7%) |
| ScvO2 | 24.8% (20.8%–29.1%) | 27.5% (23.1%–32.4%) | 53.1% (49.0%–57.2%) |
| Arterial catheter | 30.2% (25.9%–34.7%) | 28.3% (23.8%–33.2%) | 74.9% (71.2%–78.3%) |
| Passive leg raising or fluid challenge | 48.2% (43.5%–53.0%) | 47.1% (41.9%–52.3%) | 65.5% (61.5%–69.4%) |
| Hemodynamic measurement‖ | 28.2% (24.0%–32.6%) | 33.2% (28.4%–38.2%) | 55.5% (51.4%–59.6%) |
| Antibiotic stewardship | |||
| Regular consultations with infectious diseases specialists | 29.7% (25.5%–34.2%) | 40.1% (35.1%–45.3%) | 39.6% (35.6%–43.6%) |
| Procalcitonin guided antiinfective therapy | 47.7% (43.0%–52.5%) | 52.7% (47.5%–57.8%) | 72.7% (68.9%–76.2%) |
| MRSA testing | 19.4% (15.8%–23.4%) | 26.5% (22.1%–31.3%) | 36.7% (32.8%–40.7%) |
Definition of abbreviations: MAP = mean arterial pressure; MRSA = methicillin-resistant Staphylococcus aureus; ScvO2 = central venous O2 saturation; SOFA = Sequential Organ Failure Assessment.
Data in parentheses are 95% CIs.
*
Begin rapid administration of 30 ml/kg of crystalloid for hypotension or lactate level ⩾4 mmol/L.
†
Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain MAP ⩾65 mm Hg.
‡
By clinical chemistry: white blood cells, coagulation, renal and liver function.
§
Examples: urine, swabs, cerebrospinal fluid.
‖
Cardiac output, stroke volume, pulse pressure measurement.