Factors Influencing Variability in Compliance Rates and Clinical Outcomes Among Three Different Severe Sepsis Bundles

2007 ◽  
Vol 41 (6) ◽  
pp. 929-936 ◽  
Author(s):  
Jeffrey J Fong ◽  
Karen Cecere ◽  
John Unterborn ◽  
Erik Garpestad ◽  
Mark Klee ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Quality Indicators ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Healthcare Organizations ◽  
Patient Factors ◽  
Sepsis Bundles ◽  
Factors Associated ◽  
Healthcare Improvement ◽  
Bundle Compliance

BACKGROUND: While 3 different quality indicator bundles are either approved (Voluntary Hospitals of America [VHA], Institute for Healthcare Improvement [IHI]) or proposed (Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) to rate clinical practices in treatment of severe sepsis, it is suspected that differences in the quality indicators among these bundles may lead to discrepant benchmarking data. OBJECTIVE: To compare bundle compliance and patient factors associated with it among the IHI, JCAHO, and VHA severe sepsis bundles and explore possible reasons for any observed variability. METHODS: Using a retrospective, noninterventional design, we evaluated 50 adults (APACHE II score 25 ± 6, organ failure 2 ± 1, and shock 52%) with severe sepsis who were admitted consecutively to an intensive care unit at a 450 bed university-affiliated hospital. RESULTS: Few patients met 100% (IHI 6%, JCAHO 0%, VHA 6%) or 75% or greater (IHI 22%, JCAHO 6%, VHA 22%) of the quality indicators in each bundle. The number of patients who met 50% or more of the quality indicators varied significantly between JCAHO (28%) and both IHI (66%; p < 0.001) and VHA (60%; p < 0.001), but not between IHI and VHA (p = 0.53). Compliance with 50% or more of the quality indicators was more likely to occur when patients had shock (IHI, JCAHO, VHA), an APACHE II score greater than or equal to 25 (VHA), 2 or more organ failures (VHA), or survived hospitalization (IHI). We identified a number of factors that may help explain these differences. CONCLUSIONS: Differences among the IHI, JCAHO, and VHA severe sepsis bundles lead to variability in bundle compliance rates and the patient factors associated with the variability and may lead to confusion when benchmarking practices among institutions. Future efforts should focus on developing a single valid and reliable bundle that allows providers to improve the quality of sepsis care. TRANSFONDO: Tres diferentes organizaciones [“Voluntary Hospitals of America” (VHA), “Institute for Healthcare Improvement” (IHI), “Joint Commission on Accreditation of Healthcare Organizations” (JCAHO)] encargados con mejorar el cuidado médico en instituciones han desarrollado criterios de indicadores de calidad para el manejo apropiado de sepsis. Estas guiás de tratamiento han sido desarrollados con el propósito de proveer instituciones con un mecanismo para comparar la calidad de cuidado que ofrecen a sus pacientes que son admitidos con sepsis severa. Mientras que se han aprobado o propuesto tres diversos criterios de indicadores de calidad para evaluar las prácticas clínicas del manejo de sepsis severa, se sospecha que las diferencias entre estos indicadores pueden resultar en datos de comparación discrepantes.

The Relationship of the ACCP/SCCM Consensus Conference Classification of Sepsis to Mortality and Multiorgan Dysfunction among Medical ICU Patients

1996 ◽  
Vol 11 (6) ◽  
pp. 326-334 ◽  
Author(s):  
Marin H. Kollef ◽  
Paul R. Eisenberg
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Consensus Conference ◽  
Organ System ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Patients ◽  
Multiorgan Dysfunction

To determine the relation between the proposed ACCP/SCCM Consensus Conference classification of sepsis and hospital outcomes, we conducted a single-center, prospective observational study at Barnes Hospital, St. Louis, MO, an academic tertiary care hospital. A total of 324 consecutive patients admitted to the medical intensive care unit (ICU) were studied for prospective patient surveillance and data collection. The main outcome measures were the number of acquired organ system derangements and hospital mortality. Fifty-seven (17.6%) patients died during the study period. The proposed classifications of sepsis (e.g., systemic inflammatory response syndrome [SIRS], sepsis, severe sepsis, septic shock) correlated with hospital mortality ( r = 0.330; p < 0.001) and development of an Organ System Failure Index (OSFI) of 3 or greater ( r = 0.426; p < 0.001). Independent determinants of hospital mortality for this patient cohort ( p < 0.05) were development of an OSFI of 3 or greater (adjusted odds ratio [AOR], 13.9; 95% confidence interval [CI], 6.4–30.2; p < 0.001); presence of severe sepsis or septic shock (AOR, 2.6; 95% CI, 1.2–5.6; p = 0.002), and an APACHE II score ≥ of 18 or greater (AOR, 2.4; 95% CI, 1.0–5.8; p = 0.045). Intra-abdominal infection (AOR, 19.1; 95% CI, 1.6–230.1; p = 0.011), an APACHE II score ≥ of 18 or greater (AOR, 8.9; 95% CI, 4.2–18.6; p < 0.001), and presence of severe sepsis or septic shock (AOR, 2.9; 95% CI, 1.5–5.4; p = 0.001) were independently associated with development of an OSFI of 3 or greater. These data confirm that acquired multiorgan dysfunction is the most important predictor of mortality among medical ICU patients. In addition, they identify the proposed ACCP/SCCM Consensus Conference classification of sepsis as an additional independent determinant of both hospital mortality and multiorgan dysfunction.

scholarly journals Traditional Chinese Medicine Diagnosis “Yang-Xu Zheng”: Significant Prognostic Predictor for Patients with Severe Sepsis and Septic Shock

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Sunny Jui-Shan Lin ◽  
Yung-Yen Cheng ◽  
Chih-Hung Chang ◽  
Cheng-Hung Lee ◽  
Yi-Chia Huang ◽  
...  
Keyword(s):  
Septic Shock ◽  
Regression Analysis ◽  
Severe Sepsis ◽  
Host Response ◽  
Multivariate Logistic Regression Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Multivariate Logistic Regression ◽  
Sepsis Mortality ◽  
Sepsis And Septic Shock

Pathogenesis of sepsis includes complex interaction between pathogen activities and host response, manifesting highly variable signs and symptoms, possibly delaying diagnosis and timely life-saving interventions. This study applies traditional Chinese medicine (TCM)Zhengdiagnosis in patients with severe sepsis and septic shock to evaluate its adaptability and use as an early predictor of sepsis mortality. Three-year prospective observational study enrolled 126 septic patients. TCMZhengdiagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor-α, Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit. Main outcome was 28-day mortality; multivariate logistic regression analysis served to determine predictive variables of the sepsis mortality. APACHE II score, frequency ofNutrient-phase heat, andQi-XuandYang-Xu Zhengswere significantly higher in nonsurvivors. The multivariate logistic regression analysis identifiedYang-Xu Zhengas the outcome predictor. APACHE II score and levels of five host response cytokines between patients with and withoutYang-Xu Zhengrevealed significant differences. Furthermore, cool extremities and weak pulse, both diagnostic signs ofYang-Xu Zheng, were also proven independent predictors of sepsis mortality. TCM diagnosis “Yang-Xu Zheng” may provide a new mortality predictor for septic patients.

scholarly journals Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution

2004 ◽  
Vol 180 (2) ◽  
pp. 347-350 ◽  
Author(s):  
I Rodriguez ◽  
E Fluiters ◽  
LF Perez-Mendez ◽  
R Luna ◽  
C Paramo ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Single Institution ◽  
Mean Values ◽  
Serum Free ◽  
Factors Associated ◽  
The Mean ◽  
Main Factors ◽  
Glasgow Score

This study was carried out to investigate the clinical and biochemical factors which might be of importance in predicting the outcome of patients with myxoedema coma. Eleven patients (ten female) aged 68.1+/-19.5 years attended our institution over a period of 18 years.Glasgow and APACHE II scores and serum free thyroxine and TSH were measured in all the patients on entry. Patients were selected at random to be treated with two different regimens of l-thyroxine.Four patients died with the mortality rate being 36.4%. The patients in coma at entry had significantly higher mortality rates than those with minor degrees of consciousness (75% vs 14.3% respectively, P=0.04). The surviving patients had significantly higher Glasgow scores than those who died (11.85+/-2.3 vs 5.25+/-2.2 respectively, P<0.001). Comparison of the mean values of APACHE II scores between the surviving group and those who died was significantly different (18.0+/-2.08 vs 31.5+/-2.08 respectively, P<0.0001).The degree of consciousness, the Glasgow score and the severity of the illness measured by APACHE II score on entry were the main factors that determined the post-treatment outcome of patients with myxoedema coma.

scholarly journals Dexmedetomidine improved renal function in patients with severe sepsis: an exploratory analysis of a randomized controlled trial

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Tsuyoshi Nakashima ◽  
◽  
Kyohei Miyamoto ◽  
Nozomu Shima ◽  
Seiya Kato ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Renal Function ◽  
Severe Sepsis ◽  
Sofa Score ◽  
Controlled Trial ◽  
Mortality Rates ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Randomized Controlled ◽  
Initial Comparison

Abstract Background Dexmedetomidine has been reported to improve organ dysfunction in critically ill patients. In a recent randomized controlled trial (Dexmedetomidine for Sepsis in Intensive Care Unit (ICU) Randomized Evolution [DESIRE]), we demonstrated that dexmedetomidine was associated with reduced mortality risk among patients with severe sepsis. We performed this exploratory sub-analysis to examine the mechanism underlying improved survival in patients sedated with dexmedetomidine. Methods The DESIRE trial compared a sedation strategy with and without dexmedetomidine among 201 mechanically ventilated adult patients with sepsis across eight ICUs in Japan. In the present study, we included 104 patients with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of ≥ 23 (54 in the dexmedetomidine [DEX] group and 50 in the non-dexmedetomidine [non-DEX] group). Initially, we compared the changes in the sequential organ failure assessment (SOFA) scores from the baseline within 6 days after randomization between groups. Subsequently, we evaluated the variables comprising the organ component of the SOFA score that showed relevant improvement in the initial comparison. Results The mean patient age was 71.0 ± 14.1 years. There was no difference in the median APACHE II score between the two groups (29 [interquartile range (IQR), 25–31] vs. 30 [IQR, 25–33]; p = 0.35). The median SOFA score at the baseline was lower in the DEX group (9 [IQR, 7–11] vs. 11 [IQR, 9–13]; p = 0.01). While the renal SOFA subscore at the baseline was similar for both groups, it significantly decreased in the DEX group on day 4 (p = 0.02). During the first 6 days, the urinary output was not significantly different (p = 0.09), but serum creatinine levels were significantly lower (p = 0.04) in the DEX group. The 28-day and in-hospital mortality rates were significantly lower in the DEX group (22% vs. 42%; p = 0.03, 28% vs. 52%; p = 0.01, respectively). Conclusion A sedation strategy with dexmedetomidine is associated with improved renal function and decrease mortality rates among patients with severe sepsis. Trial registration This trial was registered on ClinicalTrials.gov (NCT01760967) on January 1, 2013.

scholarly journals Factors Associated With DNR Status After Nontraumatic Intracranial Hemorrhage

2019 ◽  
Vol 10 (3) ◽  
pp. 168-175 ◽  
Author(s):  
Kaitlyn Lillemoe ◽  
Aaron Lord ◽  
Jose Torres ◽  
Koto Ishida ◽  
Barry Czeisler ◽  
...  
Keyword(s):  
Palliative Care ◽  
Marital Status ◽  
Intracranial Hemorrhage ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Factors Associated ◽  
Significant Difference ◽  
Active Cancer

Background: We explored factors associated with admission and discharge code status after nontraumatic intracranial hemorrhage. Methods: We extracted data from patients admitted to our institution between January 1, 2013, and March 1, 2016 with nontraumatic intracerebral hemorrhage or subarachnoid hemorrhage who had a discharge modified Rankin Scale (mRS) of 4 to 6. We reviewed data based on admission and discharge code status. Results: Of 88 patients who met inclusion criteria, 6 (7%) were do not resuscitate (DNR) on admission (aDNR). Do not resuscitate on admission patients were significantly older than those who were full code on admission ( P = 0.04). There was no significant difference between admission code status and sex, marital status, active cancer, premorbid mRS, admission Glasgow Coma scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, or bleed severity. At discharge, 66 (75%) patients were full code (dFULL), 11 (13%) were DNR (dDNR), and 11 (13%) were comfort care. African American and Hispanic patients were significantly more likely to be dFULL than Asian or white patients ( P = .01) and less likely to be seen by palliative care ( P = .004). Patients with less aggressive code status had higher median APACHE II scores ( P = .008) and were more likely to have active cancer ( P = .06). There was no significant difference between discharge code status and sex, age, marital status, premorbid mRS, discharge GCS, or bleed severity. Conclusions: Limitation of code status after nontraumatic intracranial hemorrhage appears to be associated with older age, white race, worse APACHE II score, and active cancer. The role of palliative care after intracranial hemorrhage and the racial disparity in limitation and de-escalation of treatment deserves further exploration.

Patient-Specific Risk Factors Associated With the Development of Hyperchloremia in a Neurocritical Care Intensive Care Unit

2021 ◽  
pp. 089719002110268
Author(s):  
Leslie A. Hamilton ◽  
Michael L. Behal ◽  
Ashley R. Carter ◽  
A. Shaun Rowe
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Neurocritical Care ◽  
Kidney Injury ◽  
Serum Osmolality ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Factors Associated

Background: Hypertonic sodium chloride (HTS) is used in intensive care unit (ICU) settings to manage cerebral edema, intracranial hypertension, and for the treatment of severe hyponatremia. It has been associated with an increased incidence of hyperchloremia; however, there is limited literature focusing on hyperchloremic risk in neurologically injured patients. Objective: The primary objective of this study was to determine risk factors associated with development of hyperchloremia in a neurocritical care (NCC) ICU population. Methods: This was a retrospective case-control study performed in an adult NCC ICU and included patients receiving HTS. The primary outcome was to evaluate patient characteristics and treatments associated with hyperchloremia. Secondary outcomes included acute kidney injury and mortality. Results: Overall, 133 patients were identified; patients who were hyperchloremic were considered cases (n = 100) and patients without hyperchloremia were considered controls (n = 33). Characteristics and treatments were evaluated with univariate analysis and a logistic regression model. In the multivariate model, APACHE II Score, initial serum osmolality, total 3% saline volume, and total 23.4% saline volume were significant predictors for hyperchloremia. In addition, patients with a serum chloride greater than 113.5 mEq/L were found to have a higher risk of acute kidney injury (AKI) (adjusted OR 3.15; 95% CI 1.10-9.04). Conclusions: This study demonstrated APACHE II Score, initial serum osmolality, and total 3% and 23.4% saline volumes were associated with developing hyperchloremia in the NCC ICU. In addition, hyperchloremia is associated with an increased risk of AKI.

scholarly journals Comparative analysis of survival between elderly and non-elderly severe sepsis and septic shock resuscitated patients

2015 ◽  
Vol 13 (3) ◽  
pp. 357-363 ◽  
Author(s):  
Henrique Palomba ◽  
Thiago Domingos Corrêa ◽  
Eliézer Silva ◽  
Andreia Pardini ◽  
Murillo Santucci Cesar de Assuncao
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Resuscitated Patients ◽  
Long Term Impact ◽  
Sepsis And Septic Shock

Objective To compare outcomes between elderly (≥65 years old) and non-elderly (<65 years old) resuscitated severe sepsis and septic shock patients and determine predictors of death among elderly patients.Methods Retrospective cohort study including 848 severe sepsis and septic shock patients admitted to the intensive care unit between January 2006 and March 2012.Results Elderly patients accounted for 62.6% (531/848) and non-elderly patients for 37.4% (317/848). Elderly patients had a higher APACHE II score [22 (18-28)versus 19 (15-24); p<0.001], compared to non-elderly patients, although the number of organ dysfunctions did not differ between the groups. No significant differences were found in 28-day and in-hospital mortality rates between elderly and non-elderly patients. The length of hospital stay was higher in elderly compared to non-elderly patients admitted with severe sepsis and septic shock [18 (10-41)versus 14 (8-29) days, respectively; p=0.0001]. Predictors of death among elderly patients included age, site of diagnosis, APACHE II score, need for mechanical ventilation and vasopressors.Conclusion In this study population early resuscitation of elderly patients was not associated with increased in-hospital mortality. Prospective studies addressing the long-term impact on functional status and quality of life are necessary.

scholarly journals TO STUDY THE ROLE OF PLATELET INDICES (MPV, PDW, PCT, PLCR) AS PROGNOSTIC MARKERS IN COMPARISON WITH APACHE II AND SAPS 3 SCORES IN SEVERE SEPSIS

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Ramesh Kumar ◽  
Laxmi . ◽  
Maniram Kumhar ◽  
Arunarya .
Keyword(s):  
Severe Sepsis ◽  
Prognostic Marker ◽  
Mean Platelet Volume ◽  
Prognostic Markers ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Platelet Volume ◽  
Platelet Indices ◽  
Saps 3

Background: Platelet indices including mean platelet volume (MPV), platelet volume distribution width (PDW), plateletcrit (PCT) and platelet large cell ratio (PLCR), these indices can be measured by an inexpensive and readily available routine blood count and may be useful as a prognostic marker in patients with sepsis Methods: This study was planned to establish platelet indices as a prognostic marker in comparison with APACHE II and SAPS 3 score in severe sepsis patients admitted in Medical Intensive Care Unit under Department of Medicine, Jawahar Lal Nehru Medical College & Hospital, Ajmer. Results: In our study, higher Mean Platelet Volume(MPV) on day 7 was associated with higher APACHE II score, and this difference was statistically significant (p value-0.001). Also, higher Mean Platelet Volume (MPV) on day 7 was associated with higher SAPS III score, and this difference was statistically significant (p value-0.01). Conclusion: In developing countries like India platelet indices (specially MPV and PDW) measured on admission and subsequently can be used as prognostic markers in severe sepsis in emergency and critical care setup. Keywords: MPV, Sepsis, APACHE II, SAPS 3

scholarly journals Factors associated with nursing workload in three intensive care units

2021 ◽  
Vol 55 ◽  
Author(s):  
Diana Isabel Cáceres Rivera ◽  
Claudia Consuelo Torres ◽  
Luis Alberto López Romero
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Diagnostic Category ◽  
Multiple Linear Regression Model ◽  
Apache Ii ◽  
Nursing Workload ◽  
Bivariate Analysis ◽  
Apache Ii Score ◽  
Cross Sectional ◽  
Factors Associated

ABSTRACT Objective: To determine the nursing workload in intensive care units (ICUs) and the factors associated with the Nursing Activities Score (NAS). Method: An analytical cross-sectional study was carried out in three ICUs in Bucaramanga, Colombia, between February 2018 and February 2020. The nursing workload was estimated based on the NAS. A descriptive and bivariate analysis stratified by ICU was performed using a robust multiple linear regression model, and the factors associated with the nursing workload (p < 0.05) were estimated. Results: In this study, 362 records were included. The median NAS was 68.1 points (Q1:47.2–Q3:116.7). APACHE II (β = 3.13, CI: 95% 2.28; 3.98), days of stay in ICU ≥3 (β = 16.78, CI: 95% 6.15; 27.41), surgery provenance service (β = 22.31, CI: 95% 9.76; 34.86), and traumatology and emergencies diagnostic category (β = 33.72, CI 95%: 9.90; 57.53) were associated with high NAS scores. Conclusion: The nursing staff spend approximately 70% of their time on a single patient, and administrative work takes up most of their time. Hospital stays of longer than 3 days, high APACHE II score, coming from the surgery department, and having a diagnosis of trauma and emergency were associated with a high workload.

scholarly journals Improving of APACHE II score at the early phase using CTR-001 direct hemoperfusion in patients with severe sepsis and septic shock

Critical Care ◽  
2009 ◽  
Vol 13 (Suppl 1) ◽  
pp. P285 ◽  
Author(s):  
Y Suzuki ◽  
N Sato ◽  
M Kojika ◽  
T Kikkawa ◽  
T Shouzushima ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Early Phase ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Direct Hemoperfusion ◽  
Sepsis And Septic Shock
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