Medical News Stories
Delay Within the 3-Hour Surviving Sepsis Campaign Guideline on Mortality for Patients with Severe Sepsis and Septic Shock
Pruinelli L, Westra BL, Yadav P, et al. Crit Care Med. 2018; 46: 500-5.
Study Question: Are delays in specific 3-hour bundle Surviving Sepsis Campaign guideline recommendations associated with increased in-hospital mortality in patients with sepsis and septic shock?
Study Description: This retrospective cohort included medical and surgical patients, ≥18 years of age hospitalized with a billing diagnosis of severe sepsis or septic shock within one health system in the United States. Data was collected between January 1, 2011 and July 31, 2015. Pertinent exclusion included the following: at least two of the criteria for sepsis suspicion not met; guideline recommended treatment not administered before discharge; missing antibiotic therapy, respiratory rate or WBC data. The primary endpoint was to evaluate the impact of delayed implementation of the components of the 3-hour Surviving Sepsis guideline recommendation. The 3-hour Surviving Sepsis guideline recommendations include the following: obtain a blood culture before antibiotic administration, measure a lactate level, administer broad-spectrum antibiotics and administer 30 mL/kg of crystalloid fluid for hypotension (defined as a mean arterial pressure < 65 mmHg or lactate > 4 mmol/L).
Results: The study included 5,072 patients with severe sepsis or septic shock, of which 1,412 (27.8%) died in the hospital. Only 4.2% of patients did not receive any of the four bundle recommendations within 3 hours and 41.1% of these patients died. A statistically significant increase in mortality was noted after a 50 minute delay in obtaining blood cultures prior to antibiotics, a 20 minute delay in obtaining a lactate level, a 125 minute delay in administering broad spectrum antibiotics and a 100 minute delay in administering crystalloids.
Conclusion(s): A delay in implementing any of the components of the 3-hour Surviving Sepsis guideline recommendation is associated with increased in-hospital mortality.
Perspective: While previous studies have shown patient harm with the delay in implementing the 3-hour sepsis bundle, this study demonstrated increased in-hospital mortality with delays less than 3 hours. The inclusion of a single healthcare system and lack of adjustment for vasopressors and mechanical ventilation were limitations of this paper. Delays with implementation of the 3-hour bundle should be minimized as best as possible.