Outcomes of Clinical Practice Guideline for Sepsis Patients
in Taksin Hospital
Supunnee Jirajariyavej MD1, Apichot So-Ngern BSc2, Terapong Tantawichien MD3, Rapeepan Soomhirun RN4
Affiliation :
1 Department of Medicine, Taksin Hospital, Bangkok, Thailand
2 Faculty of Pharmacy, Siam University, Bangkok, Thailand
3 Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn
Memorial Hospital, Bangkok, Thailand
4 Department of Nursing, Taksin Hospital, Bangkok, Thailand
Background : Sepsis is a serious disease with a high mortality rate.
Objective : To study the effect of a Clinical Practice Guideline [CPG] on mortality for sepsis patient management in Thailand.
Materials and Methods : The design was a retrospective study. The medical records of 472 severe sepsis or septic shock patients
treated prior to and after the hospital sepsis CPG implementation in hospital were reviewed.
Results : Four hundred seventy-two patients were eligible for enrollment. The mortality rate was statistically signi(cid:976)icant different
among studied patients in pre-implementation period (43.6%) and implementation period (13.1%) (p<0.001). There was statistically
higher percentage of patients who received antibiotics within the (cid:976)irst hours of being diagnosed with sepsis in implementation
period (97.9%), compared with pre-implementation period (74.2%) (p<0.001). The signi(cid:976)icant higher numbers of patients in
implementation period having enough volume replacement within the (cid:976)irst six hours of severe sepsis or septic shock diagnosis
compared with in pre-implementation period, as measured by an adequate urine output (≥0.5 ml/kg/hour) (84.6% versus 73.8%)
(p = 0.018), and by an adequate central venous pressure (8 to 12 mmHg) (82.4% versus 43.3%) (p<0.001). In addition, there were
signi(cid:976)icant difference in the percentages of patients having a reversal of septic shock in pre-implementation and implementation
period (94.8% versus 88.4%) (p = 0.02).
Conclusion : An implementation of the sepsis CPG in secondary-care hospital led to increase appropriate management and decrease
mortality among the severe sepsis patients.
Keywords : Severe sepsis, Septic shock, Clinical practice guideline for sepsis
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