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Treatment outcomes after implementation of an adapted WHO protocol for severe sepsis and septic shock in Haiti.
- Source :
-
Journal of critical care [J Crit Care] 2017 Oct; Vol. 41, pp. 222-228. Date of Electronic Publication: 2017 May 27. - Publication Year :
- 2017
-
Abstract
- Purpose: The World Health Organization (WHO) has developed a simplified algorithm specific to resource-limited settings for the treatment of severe sepsis emphasizing early fluids and antibiotics. However, this protocol's clinical effectiveness is unknown. We describe patient outcomes before and after implementation of an adapted WHO severe sepsis protocol at a community hospital in Haiti.<br />Materials and Methods: Using a before-and-after study design, we retrospectively enrolled 99 adult Emergency Department patients with severe sepsis from January through March 2012. After protocol implementation in January 2014, we compared outcomes to 67 patients with severe sepsis retrospectively enrolled from February to April 2014. We defined sepsis according to the WHO's Integrated Management of Adult Illness guidelines and severe sepsis as sepsis plus organ dysfunction.<br />Results: After protocol implementation, quantity of fluid administered increased and the physician's differential diagnoses more often included sepsis. Patients were more likely to have follow-up vital signs taken sooner, a radiograph performed, and a lactic acid tested. There were no improvements in mortality, time to fluids or antimicrobials.<br />Conclusions: Use of a simplified sepsis protocol based primarily on physiologic parameters allows for substantial improvements in process measures in the care of severely septic patients in a resource-constrained setting.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Anti-Bacterial Agents administration & dosage
Benchmarking
Drug Administration Schedule
Emergency Service, Hospital organization & administration
Female
Haiti
Hospital Mortality
Humans
Infection Control
Male
Middle Aged
Practice Guidelines as Topic
Retrospective Studies
Sepsis mortality
Shock, Septic mortality
Shock, Septic prevention & control
Treatment Outcome
World Health Organization
Anti-Bacterial Agents therapeutic use
Clinical Protocols
Emergency Service, Hospital standards
Outcome Assessment, Health Care
Sepsis prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1557-8615
- Volume :
- 41
- Database :
- MEDLINE
- Journal :
- Journal of critical care
- Publication Type :
- Academic Journal
- Accession number :
- 28591678
- Full Text :
- https://doi.org/10.1016/j.jcrc.2017.05.024