Managementofsepsis_anewbundle-ATLAS演示幻灯片.pptVIP

The 6-Hour Severe Sepsis Bundle 1) Initiate CVP/ScvO2 monitoring within 2 hours 2) Give broad spectrum antibiotics within 4 hours 3) Complete early goal directed therapy within 6 hours CVP 8 mmHg OR ?CI 15%, MAP 65 mmHg, ScvO2 70% CVP or ?CI measured by any acceptable method is used as indicator for preload CVP 12 mmHg may be appropriate for patient on mechanical ventilation 4) Monitor for decreasing lactate (lactate clearance) Nguyen HB et al. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med 2007; 35:1105-12 Data Collection Bundle QI checklist completed at the bedside Study DCF completed by study coordinator De-identified patient information Study PI to confirm accuracy of data Copies of study DCF to submit to Loma Linda University Do not submit bundle QI checklist containing patient identifiers to Loma Linda University Outcome Measurements Quarterly percentage compliance In-hospital mortality in patients with bundle completed vs not completed Study Timeline Sites maintain original copies of DCF Mail photocopies to: H. Bryant Nguyen, MD Quarterly, 15th of the month following completion of a quartile First mailing – October 15, 2008 for baseline data Patient Characteristics Laboratories Baseline Hemodynamic Profile ATLAS Bundle Outcome CVP/ScvO2 monitoring by 2 hours Abx by 3 hours EGDT by 6 hours Lactate clearance CVP/ScvO2 monitoring by 2 hours Abx by 3 hours EGDT by 6 hours Lactate clearance Data updated until November 2009: 398 patients SSC Bundle Completion and Outcome Lactate measured Cx prior to abx Fluid bolus Abx by 3 hours CVP 8 by 6 hours ScvO2 70 by 6 hours * Management of sepsis: a new bundle-ATLAS 陆一鸣 上海交通大学医学院附属瑞金医院 Definition of Sepsis By consensus, sepsis is defined as The combination of pathologic infection and physiologic changes known collectively as the sepsis inflammatory response syndrome (SIRS) at least 2 o