Emergency department implementation of a severe sepsis code

Aguirre Tejedo A, Echarte Pazos JL, Mínguez Masó S, Supervía Caparrós A, Skaf Peters E, Campodarve Botet I

Objective: To analyze the degree of compliance with a severe sepsis code and the

achievement of hemodynamic goals under that code.

Methods: Prospective observational study (October 2006 through March 2007) of

patients meeting the following sets of inclusion criteria: 1) suspicion of infection; 2)

temperature < 36ºC or >38ºC, or heart rate > 90 beats/min or respiratory rate > 20

breaths/min, or diminished level of consciousness; and 3) systolic blood pressure < 90 mm Hg, or mean arterial pressure < 70 mm Hg, or a decrease in blood pressure > 40

mm Hg in hypertensive individuals. We recorded clinical variables, degree of compliance

with measures specified in the code in the first 6 hours, success in reaching

hemodynamic goals, and hospital mortality.

Results: The mean (SD) age was 58.4 (20) years and 70.7% were men. The respiratory

tract was the most frequent focus of infection (in 50% of the cases). The code was

implemented in 64.5% of the cases. In-hospital mortality was 17.5%. Regarding

achievement of hemodynamic goals, a mean arterial pressure 65 mm Hg was reached

in 77.5%, diuresis 0.5 mL/kg/h was observed in 82.5%, and a central venous pressure

of 8 mm Hg to 12 mm Hg was reached in 45.4% and a central venous oxygen

saturation (SvcO2) of 70% in 15.6%. The level of compliance with each stipulated

measure was as follows: blood cultures before starting an antibiotic, 90%; administration

of an antibiotic within 3 hours, 95.7%; measurement of lactate level, 97.5%;

resuscitation with adequate volume, 80%; administration of noradrenalin, 80%; and

measurement of central venous pressure and SvcO2, in 72.7% and 31.2%, respectively.

Conclusions: Implementing a severe sepsis code facilitated the achievement of

consistent management of this condition. Emergency personnel were alert to detecting

sepsis and treating it early, and they became aware of aspects of care that could be

improved.

Aguirre Tejedo A, Campodarve Botet I, Echarte Pazos JL, Mínguez Masó S, Skaf Peters E, Supervía Caparrós A