Surviving Sepsis Campaign Bundles Adherence and Their Limits in Surgical Patients with Septic Shock in an ICU

Abstract

Aims: The Surviving Sepsis Campaign (SSC) guidelines aimed to reduce heterogeneity of conventional therapy and mortality. The present study was performed in septic shock to describe the adherence to the 2008 SSC guidelines, confounding factors, and limitations. Study Design: Prospective observational study. Place and Duration of Study: Clinic of Anaesthesiology, University Hospital Medical School, and Clinical Economics at the Institute of History, Philosophy and Ethics in Medicine, University of Ulm, between January 2008 and June 2009. Methodology: The adherence to 36 items of the 6-hour and 24-hour bundles of the 2008 SSC guidelines was investigated in 98 surgical patients with septic shock. Results: The adherence to the 36 items varied between 0% and 95%. Besides the categories “adherent“ and “nonadherent“, additional categories “partially adherent“, “not-applicable“ and “unknown“ were used. None of the single items alone was essential for survival. Patients with septic shock on admission (n=68) had significantly higher SOFA scores (degree of organ dysfunctions) compared to patients developing septic shock in the ICU (n = 30). Conclusion: As many confounders are limiting the adherence to complex guidelines, the complete adherence will hardly be possible in severe diseases such as septic shock. Our results suggest that efforts associated with early diagnosis and active encouragement outside the ICU are necessary to improve applicability and adherence to the SSC guidelines in patients with septic shock in order to reduce the time lag of diagnosis and treatment, which may be reached by focusing on few essential points.