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Title: Outcome effectiveness of the severe sepsis resuscitation bundle with addition of lactate clearance as a bundle item: A multi-national evaluation
Authors: Nguyen, H.B
Kuan, W.S 
Batech, M
Shrikhande, P
Mahadevan, M 
Li, C.-H
Ray, S
Dengel, A
Keywords: lactic acid
lactic acid
central venous pressure
controlled study
disease severity
emergency ward
fluid therapy
general condition improvement
health care quality
health program
major clinical study
mean arterial pressure
outcome assessment
oxygen saturation
practice guideline
priority journal
surviving sepsis campaign resuscitation bundle
tertiary health care
metabolic clearance rate
middle aged
prospective study
treatment outcome
Guideline Adherence
Lactic Acid
Metabolic Clearance Rate
Middle Aged
Practice Guidelines as Topic
Prospective Studies
Treatment Outcome
Issue Date: 2011
Citation: Nguyen, H.B, Kuan, W.S, Batech, M, Shrikhande, P, Mahadevan, M, Li, C.-H, Ray, S, Dengel, A (2011). Outcome effectiveness of the severe sepsis resuscitation bundle with addition of lactate clearance as a bundle item: A multi-national evaluation. Critical Care 15 (5) : R229. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Introduction: Implementation of the Surviving Sepsis Campaign (SSC) guidelines has been associated with improved outcome in patients with severe sepsis. Resolution of lactate elevations or lactate clearance has also been shown to be associated with outcome. The purpose of the present study was to examine the compliance and effectiveness of the SSC resuscitation bundle with the addition of lactate clearance.Methods: This was a prospective cohort study over 18 months in eight tertiary-care medical centers in Asia, enrolling adult patients meeting criteria for the SSC resuscitation bundle in the emergency department. Compliance and outcome results of a multi-disciplinary program to implement the Primary SSC Bundle with the addition of lactate clearance (Modified SSC Bundle) were examined. The implementation period was divided into quartiles, including baseline, education and four quality improvement phases.Results: A total of 556 patients were enrolled, with median (25th to 75th percentile) age 63 (50 to 74) years, lactate 4.1 (2.2 to 6.3) mmol/l, central venous pressure 10 (7 to 13) mmHg, mean arterial pressure (MAP) 70 (56 to 86) mmHg, and central venous oxygen saturation 77 (69 to 82)%. Completion of the Primary SSC Bundle over the six quartiles was 13.3, 26.9, 37.5, 45.9, 48.8, and 54.5%, respectively (P <0.01). The Modified SSC Bundle was completed in 10.2, 23.1, 31.7, 40.0, 42.5, and 43.6% patients, respectively (P <0.01). The ratio of the relative risk of death reduction for the Modified SSC Bundle compared with the Primary SSC Bundle was 1.94 (95% confidence interval = 1.45 to 39.1). Logistic regression modeling showed that the bundle items of fluid bolus given, achieve MAP >65 mmHg by 6 hours, and lactate clearance were independently associated with decreased mortality - having odds ratios (95% confidence intervals) 0.47 (0.23 to 0.96), 0.20 (0.07 to 0.55), and 0.32 (0.19 to 0.55), respectively.Conclusions: The addition of lactate clearance to the SSC resuscitation bundle is associated with improved mortality. In our study patient population with optimized baseline central venous pressure and central venous oxygen saturation, the bundle items of fluid bolus administration, achieving MAP >65 mmHg, and lactate clearance were independent predictors of outcome. © 2011 Nguyen et al.; licensee BioMed Central Ltd.
Source Title: Critical Care
ISSN: 1364-8535
DOI: 10.1186/cc10469
Rights: Attribution 4.0 International
Appears in Collections:Staff Publications

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