J Med Assoc Thai 2018; 101 (8):1115-20

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Outcomes of Clinical Practice Guideline for Sepsis Patients in Taksin Hospital
Jirajariyavej S Mail, So-Ngern A , Tantawichien T , Soomhirun R

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 significant 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 first hours of being diagnosed with sepsis in implementation period (97.9%), compared with pre-implementation period (74.2%) (p<0.001). The significant higher numbers of patients in implementation period having enough volume replacement within the first 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 significant 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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