Implementing surviving sepsis campaign bundles in China: a prospective cohort study.

BACKGROUND: Surviving sepsis campaign (SSC) bundles have been demonstrated to significantly improve survival in sepsis and septic shock patients worldwide. Compliance with these protocols and resultant mortality in sepsis patients was investigated in intensive care units (ICUs) in China.

METHODS: Adult patients with severe sepsis or septic shock treated from September 2007 to October 2008 in 11 ICUs of Chinese teaching hospitals were included. The primary outcome was compliance with resuscitation and management bundles. Secondary outcomes included individual bundle protocol impact and the effects of the completed bundle protocol number on 28-day mortality.

RESULTS: Overall compliance during 6-hr resuscitation and 24-hour management bundles were 5.5% and 17.4%, respectively, and 28-day mortality was 33.0%. Compliance with protocols for blood cultures before antibiotics (42.2%), central venous pressure ≥ 8 mmHg (65.9%), central venous oxygen saturation ≥ 70% (25.0%), and optimized glucose control (82.1%), were significantly associated with decreased 28-day mortality (P < 0.05). When adjusted for age, acute organ dysfunction, and APACHE II score, compliance with the blood culture before antibiotics protocol produced the most significant decrease in 28-day mortality (OR, 0.33; 95%CI, 0.16 - 0.70; P = 0.004). Compliance with ≥ 5 protocols in the 6-hour resuscitation bundle was also associated with lower 28-day mortality in septic shock patients (OR, 0.17; 95%CI, 0.06 - 0.54; P = 0.001).

CONCLUSIONS: Compliance with resuscitation and management bundles is generally poor in China; however, when applied, 6-hour resuscitation bundle are associated with significant reductions in 28-day mortality for sepsis patients.