Mortality and predictive factors in pediatric severe sepsis and septic shock after implementation of surviving sepsis campaign guideline in srinagarind hospital
Background and objective: Prompt treatment of
sepsis and septic shock in pediatric patients could
lead to an improved outcome. The Surviving Sepsis
Campaign have been launched to guide treatments
and has been followed by most contemporary centers.
However, it has not been widely utilized in
developing countries due to inadequate resources in
multiple levels. This study aimed to investigate mortality
rates and associated factors in children with
severe sepsis and septic shock treated in the Pediatric
Intensive Care Unit (PICU) of Srinagarind hospital,
Khon Kaen university (KKU) after the implementation
of the survival sepsis campaign guideline.
Method: A retrospective chart review was conducted
on patients aged 1 month – 15 years treated in the
PICU of Srinagarind hospital for sepsis and septic shock
in 2013 after the distribution of the sepsis bundle
guideline to pediatric residents. The mortality rate
was compared with a historical control (Patients
treated with sepsis and septic shock in 2012).
Results: Thirty patients, median aged 8.5 years (2
months – 14.5 years) were included. The two most
common co-morbidities were hematologic malignancies
(37.9%) and connective tissue disease (13%).
After the implementation of the sepsis bundle guide line, the mortality rate has significantly decreased
from 65.2% to 23.3% (p=0.002). Factors associated
with increased mortality included the DIC (OR 10.5,
95%CI 1.06 – 103.5), central venous oxygen saturation
(ScvO2) <70% (OR 16.5, 95% CI 1.0 - 250.1), and lactate
level > 4 mmol/L (OR 28.3, 95% CI 2.3 - 336.0).
Improved outcomes could potentially be explained
by adequate initial fluid resuscitation, appropriate use
of antibiotics, and earlier initiation of inotropic agents.
Conclusions: Implementation of the sepsis bundle
guideline in a tertiary care center in developing country
lead to outcome improvement. A multicenter
prospective study in a larger population could better
clarify its role in developing countries
Keywords
Guideline implementation septic shock severe sepsis severe sepsis resuscitation bundle Surviving Sepsis Campaign