Resuscitation in the First 3 Hours of Sepsis-Induced Hypotension Varies by Patient and Hospital Factors

Overview

Journal Crit Care Explor

Specialty Critical Care

Date 2023 Feb 13

PMID 36778909

Authors

Jen-Ting Chen

Russel J Roberts

Jonathan Eliot Sevransky

Michelle Ng Gong

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate variability in compliance to the 3-hour surviving sepsis campaign (SSC) bundle and explore the association of early compliance with subsequent shock and in-hospital mortality.

Design: Retrospective cohort study between September 2017 and February 2018.

Setting: Thirty-four academic medical centers.

Participants: A subgroup sepsis-induced hypotensive patients from a larger shock cohort study.

Main Outcomes And Measures: Compliance to SSC bundle that was defined as receiving appropriate antibiotics, 30 mL/kg of crystalloid or initiation of vasopressors, and lactate, obtained in the first 3 hours following sepsis-induced hypotension.

Results: We included 977 patients with septic-induced hypotension. Bundle compliance was 43.8%, with the lowest compliance to fluid or vasopressor components (56%). Patients with high Sequential Organ Failure Assessment scores and physiologic assessments were more likely to receive compliant care, as were patients with sepsis-induced hypotension onset in the emergency department (ED) or admitted to mixed medical-surgical ICUs. SSC compliance was not associated with in-hospital mortality (adjusted odds ratio, 0.72; 95% CI, 0.47-1.10). The site-to-site variability contributed to SSC compliance (intraclass correlation coefficient [ICC], 0.15; 95% CI, 0.07-0.3) but not in-hospital mortality (ICC, 0.02; 95% CI, 0.001-0.24). Most patients remained in shock after 3 hours of resuscitation (SSC compliant 81.1% and noncompliant 53.7%). Mortality was higher among patients who were persistently hypotensive after 3 hours of resuscitation for both the SSC compliant (persistent hypotension 37% vs not hypotensive 27.2%; = 0.094) and noncompliant (30.1% vs 18.2%; = 0.001, respectively).

Conclusions And Relevance: Patients with a higher severity of illness and sepsis-induced hypotension identified in the ED were more likely to receive SSC-compliant care. SSC compliance was not associated with in-hospital mortality after adjusting for patient- and hospital-level differences. Higher mortality is seen among those who remain in shock after initial resuscitation, regardless of SSC compliance.

Citing Articles

Bundle compliance patterns in septic shock and their association with patient outcomes: an unsupervised cluster analysis.

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Tsai Y, Lin Y, Chen C, Chien H, Chang H, Chiang M Biomedicines. 2024; 12(8).

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