A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital.
A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital.
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DOI：
10.3389/fped.2021.757721
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发表时间：
2021
影响因子：
2.6
通讯作者：
Troster EJ
中科院分区：
文献类型：
--
作者：
Medeiros DNM;Mafra ACCN;Carcillo JA;Troster EJ
导言：在资源有限且死亡率高的低收入和中等收入国家，很少有文献研究讨论医院遵循败血症捆绑疗法的益处。方法：这是一项在巴西低收入地区的一家公立医院进行的回顾性队列研究。我们评估了脓毒症捆绑的完成是否与减少败血症、严重败血症和感染性休克的住院死亡率以及预防感染性休克和器官功能障碍有关。依从性要求完成三项：(1)获取血细胞计数和培养、动脉或静脉血气和动脉或静脉乳酸水平；(2)在诊断的第一个小时内输注抗生素；(3)在诊断的第一个小时内输注10-20ml/kg的生理盐水。结果：2008年2月至2016年8月在急诊室接受治疗的548例脓毒症、严重脓毒症或感染性休克患儿纳入研究。在这些患者中，371名患者被纳入方案组，他们的中位住院时间较短(3天对11天；p<；0.001)，住院期间器官功能障碍较少(0对2，p<；0.001)，发生感染性休克的可能性较低。根据倾向评分分析，在实施后期间死亡率较低[2.75vs.15.4%(RR 95%IC0.13(0.06，0.27)；p<；0.001)]。结论：在巴西低收入地区的一家综合医院，一种简单、低成本的方案是可行的，并产生了良好的效果。使用方案可降低死亡率和功能障碍的进展，并与发生感染性休克的可能性降低有关。
Introduction: Few studies in the literature discuss the benefits of compliance with sepsis bundles in hospitals in low- and middle-income countries, where resources are limited and mortality is high. Methods: This is a retrospective cohort study conducted at a public hospital in a low-income region in Brazil. We evaluated whether completion of a sepsis bundle is associated with reduced in-hospital mortality for sepsis, severe sepsis, and septic shock, as well as prevention of septic shock and organ dysfunction. Bundle compliance required the completion of three items: (1) obtaining blood count and culture, arterial or venous blood gases, and arterial or venous lactate levels; (2) antibiotic infusion within the first hour of diagnosis; and (3) infusion of 10–20 ml/kg saline solution within the first hour of diagnosis. Results: A total of 548 children with sepsis, severe sepsis, or septic shock who were treated at the emergency room from February 2008 to August of 2016 were included in the study. Of those, 371 patients were included in the protocol group and had a lower median length of stay (3 days vs. 11 days; p < 0.001), fewer organ dysfunctions during hospitalization (0 vs. 2, p < 0.001), and a lower probability of developing septic shock. According to a propensity score analysis, mortality was lower during the post-implementation period [2.75 vs. 15.4% (RR 95%IC 0.13 (0.06, 0.27); p < 0.001)]. Conclusions: A simple and low-cost protocol was feasible and yielded good results at a general hospital in a low-income region in Brazil. Protocol use resulted in decreased mortality and progression of dysfunctions and was associated with a reduced probability of developing septic shock.
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影响因子：
3.7
作者：
Conn RL;McVea S;Carrington A;Dornan T
通讯作者：
Dornan T
影响因子：
8
作者：
Cruz, Andrea T.;Perry, Andrew M.;Patel, Binita
通讯作者：
Patel, Binita
影响因子：
8
作者：
Paul, Raina;Neuman, Mark I.;Melendez, Elliot
通讯作者：
Melendez, Elliot
影响因子：
8
作者：
Odetola, Folafoluwa O.;Gebremariam, Achamyeleh;Freed, Gary L.
通讯作者：
Freed, Gary L.
影响因子：
5.2
作者：
Long, Elliot;Babl, Franz E.;Duke, Trevor
通讯作者：
Duke, Trevor