Implementation of Sepsis Resuscitation Bundle in the ICU

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Implementation of Sepsis Resuscitation Bundle in
the ICU

• Bekele Afessa, MD
• Ognjen Gajic, MD
• Mayo Clinic, Rochester, MN

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Annual number of new cases
CDC HIV/AIDS Surveillance Report 2006 US Cancer
Statistics 2004 AHA 2004 Angus CCM 2001
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Annual deaths
CDC HIV/AIDS Surveillance Report 2006 US Cancer
Statistics 2004 AHA 2004 Angus CCM 2001
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Absolute risk reduction in sepsis and MI trials
Rivers NEJM 20013451368 Bernard NEJM
2001344699Lancet 1994343311 Topol EJ AJM
20021131
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WHY?

• Sepsis kills as many people as AMI.
• The case fatality rate of severe sepsis is higher
  than most diseases including AMI.
• Recent studies have shown interventions for
  sepsis treatment that compete with thrombolysis.
• WHY ARE WE IGNORING SEPSIS?

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IHI Sepsis Resuscitation Bundle

• Serum lactate measurement
• Obtaining blood culture before antibiotic
• Improving time to broad-spectrum antibiotic
• Treatment of hypotension and/or elevated lactate
  with fluids
• Administration of vasopressors for ongoing
  hypotension
• Maintaining adequate central venous pressure
• Maintaining adequate central venous oxygen
  saturation

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Do Sepsis bundles work?

• RCTs
• Rivers 2001 NEJM Mortality 46.5 Vs 30.5
• Lin 2006 Shock Mortality 71.6 Vs 53.7
• Observational studies
• Gao 2005 Crit Care Mortality 50 Vs 29
• Kortgen 2006 CCM Mortality 53 Vs 27
• Micek 2006 CCM Mortality 48.3 Vs 30
• Shapiro 2006 CCM Mortality 29.4 Vs 20.3
• Jones 2007 Chest Mortality 27 Vs 18
• Nguyen 2007 CCM Mortality 39.5 Vs 20.8

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Measuring performance in the non-health care
industry
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International Forum on Quality and Safety in
Healthcare 2008
?29
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Conclusions

• Written order set partially improves some aspects
  of the process of care.
• BUT the compliance rate with the sepsis
  resuscitation bundle remains low.
• Actions
• Education
• CPOE
• Feedback and systemic QI process
• Sepsis Response Team

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