Journal of Medical and Surgical Intensive Care Medicine 2010 , Vol 1, Issue 2
Implication of a Sepsis Protocol in a Respiratory Intensive Care Unit: A 12 Month Experience
Zuhal Karakurt 1 , Tülay Yarkın 1 , Özlem Yazıcıoglu Moçin 1 , Özlem Soğukpınar 1 , Eylem Acartürk 1 , Gülgün Çetintaş 1 , Ayşem Aşkım Öztin Güven 1 , Reha Baran 1 , Nalan Adıgüzel 2 , Gökay Güngör 2
1Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Respiratory Intensive Care Unit, Istanbul, Turkey
2Sağlık Bakanlığı Süreyyapaşa Göğüs ve Kalp, Damar Hastalıkları Eğitim ve Araştırma Hastanesi, Solunumsal Yoğun Bakım Ünitesi, İstanbul, Türkiye
DOI : 10.5152/dcbybd.2010.02

Aim: Protocol-directed therapy has been shown to improve patient outcome in critical illness. We aimed to evaluate the outcome of patients who were implicated in a sepsis protocol of 12 months duration and the risk factors for mortality in those patients with implicated sepsis protocol at our respiratory intensive care unit (R-ICU).

Material and Methods: This study was designed as a descriptive study. Adult patients admitted to RICU who stayed for >24 h with severe sepsis or septic shock were enrolled into the study within 2006. Demographic and clinic characteristics, treatment features, and outcome were evaluated. Modified sepsis protocol: 1. EGDT: fluid resuscitation (MAP>65mmHg); 2.LTV: Low Tidal Volume (6ml/kg ideal body weight), 3. TGC: Insulin infusion to obtain blood glucose between 80-140mg/L was utilized for all of the patients with hyperglycemia, 4. MDS: Methylprednisolone (20mg 3x/d for 7 d) in case of refractory shock. These  were recorded in the first 6 hours of shock. For determination of mortality risk factors in patients with severe sepsis, logistic regression analysis was done.

Results: During the study period, among the 176 patients admitted to RICU, 119 (67.6%) patients with severe sepsis were enrolled into the study. Mean APACHE II score on admission to RICU in patients with severe sepsis was 20.5±6.8. When comparing survivor and non-survivor patients with severe sepsis, non-survivors had a higher APACHE II score, higher rate of invasive mechanical ventilation, vasopressor use, human albumin, insulin infusion, total parenteral nutrition (TPN), and multiple organ failure (MOF). The presence of MOF, TPN and higher APACHE II score  (p<0.0001, OR.23.8, CI:7.17-78.85, p<0.020, OR4.5, CI: 1.26- 16.9, p<0.036, OR:1.1, CI: 1.006- 1.19, respectively) were shown as mortality risk factors in severe sepsis patients with implicated sepsis protocol in logistic regression analysis.

Conclusion: We observed a lower mortality rate according to APACHE II score in severe sepsis patients with applied sepsis protocol. MOF, TPN, and higher APACHE II score were found to berisk factors for mortality in those patients. We concluded that  lower mortality can be achieved if we recognize and treat severe sepsis patients early and prevent organ failure. 

Keywords : Severe Sepsis, septic shock, mortality, early goal directed therapy