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The article offers information on the 2016 Surviving Sepsis Guidelines and tells the readers the ways in which they can utilize it. Topics discussed include the tips for septic patients management in the guidelines, the tips for medical care, and the application of fluid resuscitation in patients with adult septic shock.

Purpose: To determine the association between compliance with the Surviving Sepsis Campaign (SSC) performance bundles and mortality. Design: Compliance with the SSC performance bundles, which are based on the 2004 SSC guidelines, was measured in 29,470 subjects entered into the SSC database from January 1, 2005 through June 30, 2012. Compliance was defined as evidence that all bundle elements were achieved. Setting: Two hundred eighteen community, academic, and tertiary care hospitals in the United States, South America, and Europe. Patients: Patients from the emergency department, medical and surgical wards, and ICU who met diagnosis criteria for severe sepsis and septic shock. Methods: A multifaceted, collaborative change intervention aimed at facilitating adoption of the SSC resuscitation and management bundles was introduced. Compliance with the SSC bundles and associated mortality rate was the primary outcome variable. Results: Overall lower mortality was observed in high (29.0 %) versus low (38.6 %) resuscitation bundle compliance sites ( p < 0.001) and between high (33.4 %) and low (32.3 %) management bundle compliance sites ( p = 0.039). Hospital mortality rates dropped 0.7 % per site for every 3 months (quarter) of participation ( p < 0.001). Hospital and intensive care unit length of stay decreased 4 % (95 % CI 1-7 %; p = 0.012) for every 10 % increase in site compliance with the resuscitation bundle. Conclusions: This analysis demonstrates that increased compliance with sepsis performance bundles was associated with a 25 % relative risk reduction in mortality rate. Every 10 % increase in compliance and additional quarter of participation in the SSC initiative was associated with a significant decrease in the odds ratio for hospital mortality. These results demonstrate that performance metrics can drive change in clinical behavior, improve quality of care, and may decrease mortality in patients with severe sepsis and septic shock. [ABSTRACT FROM AUTHOR]

The Surviving Sepsis Campaign (SSC or “the Campaign”) developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes. A multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were “bundled” into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008. Data from 15,022 subjects at 165 sites were analyzed to determine the compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 years ( P < 0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years ( P = 0.008). Compliance with all bundle elements increased significantly, except for inspiratory plateau pressure, which was high at baseline. Unadjusted hospital mortality decreased from 37 to 30.8% over 2 years ( P = 0.001). The adjusted odds ratio for mortality improved the longer a site was in the Campaign, resulting in an adjusted absolute drop of 0.8% per quarter and 5.4% over 2 years (95% CI, 2.5–8.4%). The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts. [ABSTRACT FROM AUTHOR]

Objective: To determine the utility of an initial serum lactate measurement for identifying high risk of death in patients with infection.Design and Setting: Post-hoc analysis of a prospectively compiled registry in an urban academic hospital.Participants: Patients with (a) a primary or secondary diagnosis of infection and (b) lactate measurement who were admitted over the 18 months following hospital-wide implementation of the Surviving Sepsis Campaign guideline for lactate measurement in patients with infection and possible severe sepsis. There were 1,177 unique patients, with an in-hospital mortality of 19%.Measurements and Results: Outcome measures included acute-phase (or=4.0 mmol/l and performed a Bayesian analysis to determine its impact on a full range (0.01-0.99) of hypothetical pretest probability estimates for death. In-hospital mortality was 15%, 25%, and 38% in low, intermediate, and high lactate groups, respectively. Acute-phase deaths and in-hospital deaths increased linearly with lactate. An initial lactate >or=4.0 mmol/l was associated with sixfold higher odds of acute-phase death; however, a lactate level less than 4 mmol/l had little impact on probability of death.Conclusions: When broadly implemented in routine practice, measurement of lactate in patients with infection and possible sepsis can affect assessment of mortality risk. Specifically, an initial lactate >or=4.0 mmol/l substantially increases the probability of acute-phase death. [ABSTRACT FROM AUTHOR]