Open AccessJournal Article
Supplement to: Time to treatment and mortality during mandated emergency care for sepsis.
TLDR
More rapid completion of a 3‐hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completed of an initial bolus of intravenous fluids, were associated with lower risk‐adjusted in‐hospital mortality.Abstract:
BACKGROUND In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. METHODS We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3‐hour bundle of care for patients with sepsis (i.e., blood cultures, broad‐spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3‐hour bundle and risk‐adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. RESULTS Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3‐hour bundle completed within 3 hours. The median time to completion of the 3‐hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3‐hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk‐adjusted in‐hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21). CONCLUSIONS More rapid completion of a 3‐hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk‐adjusted in‐hospital mortality. (Funded by the National Institutes of Health and others.)read more
Citations
More filters
Journal ArticleDOI
Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study
Kristina E. Rudd,Sarah Charlotte Johnson,Kareha M Agesa,Katya Anne Shackelford,Derrick Tsoi,Daniel Kievlan,Danny V. Colombara,Kevin S Ikuta,Kevin S Ikuta,Niranjan Kissoon,Simon Finfer,Carolin Fleischmann-Struzek,Flávia Ribeiro Machado,Konrad Reinhart,Kathryn M Rowan,Christopher W. Seymour,R. Scott Watson,R. Scott Watson,T. Eoin West,Fatima Marinho,Simon I. Hay,Simon I. Hay,Rafael Lozano,Rafael Lozano,Alan D. Lopez,Alan D. Lopez,Derek C. Angus,Christopher J L Murray,Christopher J L Murray,Mohsen Naghavi,Mohsen Naghavi +30 more
TL;DR: Despite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa.
Journal ArticleDOI
The Surviving Sepsis Campaign Bundle: 2018 update
TL;DR: In response to the publication of “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016” [12, 13], a revised “hour-1 bundle” has been developed and is presented below.
Journal ArticleDOI
Sepsis and septic shock
TL;DR: Improved basic care driven by education and quality-improvement programmes offers the best hope of increasing favourable outcomes in sepsis.
Journal ArticleDOI
Enhancing Recovery From Sepsis: A Review
TL;DR: Although there is a paucity of clinical trial evidence to support specific postdischarge rehabilitation treatment, experts recommend referral to physical therapy to improve exercise capacity, strength, and independent completion of activities of daily living in the months after hospital discharge for sepsis.
Journal ArticleDOI
An Interpretable Machine Learning Model for Accurate Prediction of Sepsis in the ICU.
Shamim Nemati,Andre Holder,Fereshteh Razmi,Matthew D. Stanley,Gari D. Clifford,Gari D. Clifford,Timothy G. Buchman,Timothy G. Buchman +7 more
TL;DR: Using data available in the ICU in real-time, Artificial Intelligence Sepsis Expert can accurately predict the onset of sepsis in an ICU patient 4–12 hours prior to clinical recognition.
References
More filters
Journal ArticleDOI
2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
Mitchell M. Levy,Mitchell P. Fink,John C. Marshall,Edward Abraham,Derek C. Angus,Deborah J. Cook,Jonathan M. Cohen,Steven M. Opal,Jean Louis Vincent,Graham Ramsay +9 more
TL;DR: A hypothetical model for staging sepsis is presented, which, in the future, may better characterize the syndrome on the basis of predisposing factors and premorbid conditions, the nature of the underlying infection, the characteristics of the host response, and the extent of the resultant organ dysfunction.
Journal ArticleDOI
Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
Christopher W. Seymour,Vincent X. Liu,Theodore J. Iwashyna,Frank M. Brunkhorst,Thomas D. Rea,André Scherag,Gordon D. Rubenfeld,Jeremy M. Kahn,Manu Shankar-Hari,Mervyn Singer,Clifford S. Deutschman,Gabriel J. Escobar,Gabriel J. Escobar,Gabriel J. Escobar,Derek C. Angus +14 more
TL;DR: To evaluate the validity of clinical criteria to identify patients with suspected infection who are at risk of sepsis, a new model derived using multivariable logistic regression in a split sample was derived.
Journal ArticleDOI
Sepsis in European intensive care units: results of the SOAP study.
Jean Louis Vincent,Yasser Sakr,Charles L. Sprung,V. Marco Ranieri,Konrad Reinhart,Herwig Gerlach,Rui Moreno,Jean Carlet,Jean-Roger Le Gall,Didier Payen +9 more
TL;DR: This large pan-European study documents the high frequency of sepsis in critically ill patients and shows a close relationship between the proportion of patients with sepsi and the intensive care unit mortality in the various countries.
Journal ArticleDOI
Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study
Kristina E. Rudd,Sarah Charlotte Johnson,Kareha M Agesa,Katya Anne Shackelford,Derrick Tsoi,Daniel Kievlan,Danny V. Colombara,Kevin S Ikuta,Kevin S Ikuta,Niranjan Kissoon,Simon Finfer,Carolin Fleischmann-Struzek,Flávia Ribeiro Machado,Konrad Reinhart,Kathryn M Rowan,Christopher W. Seymour,R. Scott Watson,R. Scott Watson,T. Eoin West,Fatima Marinho,Simon I. Hay,Simon I. Hay,Rafael Lozano,Rafael Lozano,Alan D. Lopez,Alan D. Lopez,Derek C. Angus,Christopher J L Murray,Christopher J L Murray,Mohsen Naghavi,Mohsen Naghavi +30 more
TL;DR: Despite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa.
Journal ArticleDOI
Benchmarking the incidence and mortality of severe sepsis in the United States.
TL;DR: There is substantial variability in incidence and mortality of severe sepsis depending on the method of database abstraction used, and a uniform, consistent method is needed for use in national registries to facilitate accurate assessment of clinical interventions and outcome comparisons between hospitals and regions.
Related Papers (5)
Surviving Sepsis Guidelines A Continuous Move Toward Better Care of Patients With Sepsis
Daniel De Backer,Todd Dorman +1 more