Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

01.10.2012 | original article | Ausgabe 19-20/2012

Wiener klinische Wochenschrift 19-20/2012

Do clinical guidelines improve management of sepsis in critically ill elderly patients? A before-and-after study of the implementation of a sepsis protocol

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 19-20/2012
Autoren:
MD Hans Juergen Heppner, MD Katrin Singler, MD Anja Kwetkat, MD Steffen Popp, PhD Adelheid Susanne Esslinger, MD Philipp Bahrmann, MD Matthias Kaiser, MD Thomas Bertsch, MD Cornel Christian Sieber, MD Michael Christ
Wichtige Hinweise
Hans Jüergen Heppner and Katrin Singler contributed equally to this manuscript.
This paper was presented in abstract form at the Weimar Sepsis Update 2011 [Heppner HJ, et al. Sepsis in geriatric patients: Process oriented knowledge management. Infection. 2011;39:S127–8] and the 7th Congress of the European Geriatric Medicine Society, Malaga 2011 [Heppner HJ, et al. Sepsis in geriatric patients. Eur Geriatr Med. 2011; 2S:S105–6].

Summary

Aim

Guidelines for the management of sepsis have been published but not validated for elderly patients, though a prompt work-up and initiation of appropriate therapy are crucial. This study assesses the impact of a sepsis protocol on timelines for therapy and mortality in standardized management.

Methods

Consecutive patients aged 70 years and older who were diagnosed with sepsis and admitted during the observation periods were included in this before-and-after study at a medical intensive care unit (ICU). Age, sex, and process-of-care variables including timely administration of antibiotics, obtaining blood cultures before the start of antibiotics, documenting central venous pressure, evaluation of central venous blood oxygen saturation, fluid resuscitation, and patient outcome were recorded.

Results

A total of 122 patients were included. Sepsis was diagnosed in 22.9 % of patients prior to the introduction of the protocol and 57.4 % after introduction. Volume therapy was conducted in 63.9 % of the patients (11.5 % preprotocol). Blood culture samples were taken prior to the administration of antibiotics in 67.2 % of patients (4.9 % preprotocol), and antibiotics were applied early in 72.1 % of patients (32.8 % preprotocol). Lactate was set in 77.0 % of patients (11.5 % preprotocol). A central venous catheter was inserted in 88.5 % of patients (68.9 % preprotocol), and the target central venous pressure was achieved in 64.3 % of patients (47.2 % preprotocol). ICU mortality was reduced by 5.2 % and hospital mortality by 6.4 %.

Conclusions

The use of standardized order sets for the management of sepsis in elderly patients should be strongly recommended for better performance in treatment. Compliance with the protocol was associated with reduced length of stay, reduced mortality, and improved initial appropriate therapy.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 19-20/2012

Wiener klinische Wochenschrift 19-20/2012 Zur Ausgabe

MUW resarcher of the month

Researcher of the month, Oktober 2012