The Compliance Of Implementing Sepsis Bundles And Their Effects On Outcomes Of Patients With Severe Sepsis

Objective To investigate the case fatality rate and the risk factors in critically ill patients with severe sepsis;To evaluate the compliance of implementing sepsis bundles in the ICU and their effect on outcomes of patients with severe sepsis, and analysis the prognosis effect of sepsis bundle treatment on severe sepsis.Methods The data of 149 patients with severe sepsis were studied retrospectively, these patients were received treatment in ICU of Ningxia Medical University Hospital from January 2005 to August 2010. First, choose the 120 patients from January 2005 to December 2009. Calculating mortality ,and recording the patients' general condition and clinical information, etc. Simple logistic regression was done to analyze all the risk factors, and statistically significant variables were selected (p<0.05) and used in multivariate and unconditioned Logistic regression analysis. Then choose the 149 patients, The compliance of performing sepsis bundles was recorded. All patients were separately divided into two groups on who reach the 6-hour and the 24-hour goal, or not reach the 6-hour and the 24-hour goal . Age,gender,nation,ICU stay,APACHEⅡ,SOFA,GCS and the 28-day mortality rate were compared between the two groups. Last,149 patients were divided into survival group and death group. To discover the independent factors, analyzing the relationship between sepsis bundle index and prognosis at 6 hour and 24 hour by Logistic regression analysis.Results The overall mortality of severe sepsis was 70.0% (84/120) in ICU of Ningxia Medical University Hospital from 2005 to 2010. The mortality of severe sepsis in five years was not change significantly ( P=0.954. Multivariate analysis showed that aging,APACHEⅡscore and the number of failed organ were independent factors for the patients with severe sepsis. Compliance with the bundle was low, Compliance with the 6-hour bundle was 46.3%,and the 24-hour bundle was 45.2%. The 28-day mortality rate of the patients who reach the 6-hour and 24-hour goal is more lower than the patients who were not reach the 6-hour and 24-hour goal(P<0.05). Through analysis of logistic regression, it could be find that 6hEGDT was the independent protective factor of death.Conclusion The mortality of severe sepsis was high. Aging,initial APACHEⅡscore≥20 points, or/and the number of failed organ were higher risk to the patients with severe sepsis. Correct application of the sepsis bundles can do more to improve the outcome of patients with severe sepsis, especially 6hEGDT.we should improve the compliance of implementing sepsis bundles.