Objective: To evaluate the occurrence of severe sepsis and septic shock and the rate of compliance with sepsis bundle in patients with severe sepsis and septic shock in emergency department.
Methods: A prospective study was conducted on consecutive adult patients who were sent to Emergency Department of Ruijin Hospital, Shanghai Jiaotong University School of Medicine by ambulance from May to June in 2009. The occurrence of severe sepsis and septic shock, and the number of the patients in whom who met the criteria of compliance with sepsis bundle were analyzed.
Results: Nine hundred and seventeen patients who were sent to the emergency department by ambulance in that period were enrolled in the study. The number of patients with severe sepsis and septic shock was 96. The incidence of severe sepsis and septic shock was 10.47%. Among these patients, the number of patients in whom the sepsis bundle was complied, i.e. sepsis bundle, appropriate cultures were taken before antimicrobial therapy, placement of central venous catheter and monitoring of central venous pressure (CVP) as well as central venous oxygen saturation (ScvO₂) within 2 hours, antibiotic therapy within 3 hours, early goal directed therapy (EGDT) within 6 hours, and lactate clearance in 12 hours reached 1.04%, 3.12%, 2.08%, 83.33%, 1.04%, 23.96%. The Results were 1.19%, 3.57%, 2.38%, 83.33%, 1.19%, 26.19% and 0, 0, 0, 83.33%, 0, 8.33% in medical and surgical emergency department respectively. There was no statistical difference between the two divisions (all P>0.05).
Conclusion: The incidence of severe sepsis and septic shock was high in emergency department, but the rate of recognition of it and the compliance with sepsis bundle were inadequate. It is urgently necessary to enhance the learning and implementation of the guideline.