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Monitoring severe sepsis and therapy

Abstract number: 1732_200

Bergomi E., Antonelli M.

Severe sepsis is a serious syndrome with organ failure that may affect a large proportion of the patients admitted to the intensive care unit and whose prediction is often difficult [1]. The Surviving Sepsis Campaign (SSC) is a global programme to reduce mortality rates in severe sepsis, endorsed by 11 International Medical Societies. This Campaign produced the guidelines for management of severe sepsis and septic shock [2]. These recommendations were reviewed during the annual meeting of the Society of Critical Care Medicine held in January 2006.

The Campaign has taken an action to create National and International networks to collect data and monitor interventions. In Italy the network was settled in September 2006. But, can we monitor therapy for severe sepsis if concepts, tools, ideas and attitudes differ largely between centres? With the aim of answering this crucial question, we conducted a survey on the perception of Severe Sepsis, its diagnosis and monitoring through the national network for the Italian Chapter of the SSC.

Twenty-three participating centres (10 community and 13 teaching hospitals) responded to our survey, for a total number of 261 ICU/critical care beds. When the participants were asked to describe the methodology currently used for implementation of data in their institution, 70% of the respondents adopted a continuous data collection methodology and the other 30% a ``before and after event'' design.

On the question whether an educational tool was used to sensitise people to the campaign, 13% of the respondents declared that no specific tool was used and the other 87% (20 centres) stated that they used different educative means (mostly chart documentations and department conferences).

When asked when data collection for the diagnosis of sepsis usually takes place, thirteen respondents said that their collection occurred within 24 hours from the diagnosis, only 2 contemporary, and 8 retrospectively.

On the question how data were collected 9 institutions out of 23 (39%) answered that the SSC paper tool or database were used, 11 (47%) a combination of the two, and 3 (23%) other systems.

In 17 of the 23 centres the responsibility of data collection is assigned to the attending physician; in the remaining 5 cases residents, nurses or students collect the data, but same centres allow the simultaneous collaboration of more figures.

Partnership between ICUs and other departments to approach Sepsis in the spirit of the SSC is unfortunately scarce: only 4 (17%) of the respondents have a form of collaboration with other units. The effect of this mentality is that only 6 (26%) of the interviewed hospitals currently apply a screening for severe sepsis in the ward.

One main concept that illustrates the spirit of the SSC is the idea of an early intervention to apply the different recommendations. Again, in checking how the time of presentation of sepsis is conceived in the emergency department, in the ward and in the ICU we obtained answers that were quite diverse. Of the 23 participating institutions, 16 responded. Only 50% of physicians in the Emergency Department identified the ``presentation time'' of severe sepsis with the moment of triage or hospital admission. The remaining 50% had a sort of ``a posteriori'' diagnosis, losing the possibility of an early approach. Things are much worse looking at the ward, where in 80% of cases the moment of severe sepsis presentation corresponded to the identification of symptoms from the ``a posteriori'' reviews of the medical notes, the arrival of a critical care consultant or ICU admission. Surprisingly, in the ICU still 30% of the cases is usually diagnosed through the review of the medical reports.

Conclusions: At present, despite the tremendous effort made by the International Intensive Care Community to standardise the therapy for severe sepsis, predicating the comandements of the SSC and boundles, a large variability exists in the concept of time, tool availability, and logistics.

Reference(s)

[1] Alberti C, Brun-Buisson C, Chevret S, et al.; European Sepsis Study Group. Systemic inflammatory response and progression to severe sepsis in critically ill infected patients. Am J Respir Crit Care Med 2005 Mar 1;171(5): 461–8. Epub 2004 Nov 5. IF 8.689.

[2] Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2004 Apr; 30(4): 536–55. Epub 2004 Mar 3.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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