Critical Care Explorations (Nov 2019)

A 10-Year Longitudinal Analysis of Protocol-Based Sepsis Management in a Philippine Tertiary ICU

  • Niña M. Bumanglag, MD, FPCP,
  • Mari Des J. San Juan, MD, MBA, FPCP,
  • Jose Emmanuel M. Palo, MD, FCCM, FPSCCM,
  • for The Medical City Sepsis Alert Group,
  • Irmingarda Gueco,
  • Jude Erric Cinco,
  • Marissa Alejandria,
  • Jose Emmanuel Palo,
  • Debbie Noblezada-Uy,
  • Gerardo Briones,
  • Joanne Robles,
  • May Agno,
  • Armi Carlos,
  • Karen Ilagan,
  • Kelly Chiu,
  • Stephanie Ang,
  • Marides San Juan,
  • Nina Bumanglag,
  • Raul Destura,
  • Maan Ponte,
  • Patricia Puno-Ramos,
  • Meg Goco,
  • Israeli Roque,
  • Gemma Sarapuddin,
  • Nicco Salalima,
  • Marian Vita Nova Sodusta,
  • Roland Reyes,
  • Claire Orden,
  • Ma Patricia Therese Virata,
  • Agnes Cubillas,
  • Ma Antonia Elisa Abello,
  • Joan Kristina Diaz,
  • Lourdes Trinidad,
  • Rina Uriarte,
  • Rose Leopando,
  • Alicia Inocencio,
  • Cecil Contreras,
  • Carson Cortez

DOI
https://doi.org/10.1097/CCE.0000000000000056
Journal volume & issue
Vol. 1, no. 11
p. e0056

Abstract

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Objectives:. To compare the outcomes of sepsis management using protocol-based therapy versus non-protocolized care, assessed over 10 years. Design:. Retrospective cohort study, analyzed longitudinally with risk-adjusted control charts, referenced against hospital- and unit-level programs or interventions. Setting:. Private, tertiary teaching hospital ICU in the Philippines. Patients:. Nine-hundred fifty adult patients (19 yr old or older) diagnosed with severe sepsis or septic shock, using 2001 consensus definitions, admitted to the ICU from September 2007 to August 2017. Interventions:. Three iterations of a standard clinical pathway (including early antibiotics, prescribed fluid resuscitation, and hemodynamic management) versus concurrent non-protocolized care. Measurements and Main Results:. Seven-hundred sixty patients were in the protocol-based care group versus 190 in the non-protocolized care group. Protocol-based management was associated with lower hospital mortality (28.4% vs 44.7%; p = 0.00) and ICU mortality (24.2% vs 31.6%; p = 0.038). There were no differences in ICU or hospital length-of-stay, mechanical ventilator days, or vasoactive days. Risk-Adjusted Cumulative Sum and Risk-Adjusted Exponentially Weighted Moving Average control charts showed that a survival advantage was achieved after 1 year and was sustained over the duration of the study. Conclusions:. Protocol-based management was associated with sustained improvements in the survival of sepsis patients over 10 years in this hospital setting, after a run-in period of 1 year. Hospital- and unit-level interventions may have measurable impacts on the efficacy of sepsis clinical pathways.