医学
败血症
感染性休克
拯救脓毒症运动
队列
重症监护室
内科学
抗生素
急诊医学
重症监护医学
严重败血症
微生物学
生物
作者
Raina Paul,Matthew Niedner,Ruth Riggs,Troy Richardson,Heidi Gruhler De Souza,Jeffery J. Auletta,Frances Balamuth,Deborah Campbell,Holly Depinet,Leslie A. Hueschen,W. Charles Huskins,Sarah B Kandil,Gitte Larsen,Elizabeth H. Mack,Gregory P. Priebe,Lori Rutman,Melissa Schafer,Halden F. Scott,Pete Silver,Erika Stalets,Beth Wathen,Charles G. Macias,Richard J. Brilli
出处
期刊:Pediatrics
[American Academy of Pediatrics]
日期:2023-07-12
卷期号:152 (2)
标识
DOI:10.1542/peds.2022-059938
摘要
OBJECTIVES We sought to improve utilization of a sepsis care bundle and decrease 3- and 30- day sepsis-attributable mortality, as well as determine which care elements of a sepsis bundle are associated with improved outcomes. METHODS Children’s Hospital Association formed a QI collaborative to Improve Pediatric Sepsis Outcomes (IPSO) (January 2017–March 2020 analyzed here). IPSO Suspected Sepsis (ISS) patients were those without organ dysfunction where the provider “intended to treat” sepsis. IPSO Critical Sepsis (ICS) patients approximated those with septic shock. Process (bundle adherence), outcome (mortality), and balancing measures were quantified over time using statistical process control. An original bundle (recognition method, fluid bolus < 20 min, antibiotics < 60 min) was retrospectively compared with varying bundle time-points, including a modified evidence-based care bundle, (recognition method, fluid bolus < 60 min, antibiotics < 180 min). We compared outcomes using Pearson χ-square and Kruskal Wallis tests and adjusted analysis. RESULTS Reported are 24 518 ISS and 12 821 ICS cases from 40 children’s hospitals (January 2017–March 2020). Modified bundle compliance demonstrated special cause variation (40.1% to 45.8% in ISS; 52.3% to 57.4% in ICS). The ISS cohort’s 30-day, sepsis-attributable mortality dropped from 1.4% to 0.9%, a 35.7% relative reduction over time (P < .001). In the ICS cohort, compliance with the original bundle was not associated with a decrease in 30-day sepsis-attributable mortality, whereas compliance with the modified bundle decreased mortality from 4.75% to 2.4% (P < .01). CONCLUSIONS Timely treatment of pediatric sepsis is associated with reduced mortality. A time-liberalized care bundle was associated with greater mortality reductions.
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