Abstract:

Objective: This review is aimed to evaluate the effect of implementing the septic bundle on critically ill patients’ outcomes.

Methodology: Cochrane Collaboration, MEDLINE, CINAHL, EMBASE, Science Direct, Web of Science, Scopus and PubMed were searched, covering the period 2008 to 2019. Only cohort, case-control and randomized controlled trial studies with full text in English were eligible. Studies that discussed the effect of implementing the septic bundle on critically ill patients' outcomes were only included.

Results: Out of 1,551 articles searched, and after screening inclusion and exclusion criteria; ten articles only were met the inclusion criteria which have considered the effect of implementing a septic bundle on critically ill patients’ outcomes. All of these ten studies revealed a significant effect of the septic bundle on the clinical outcomes of critically ill patients especially mortality.

Conclusion: This review confirmed that implementing septic bundle for critically ill patients has been significantly reduced outcomes which are length of hospital stay, length of stay at emergency department, mortality probability, admission to the intensive care unit and mechanical ventilation.

References:

[1] Alvaro-Meca, A., Jiménez-Sousa, M. A., Micheloud, D., Sánchez-Lopez, A., Heredia-Rodríguez, M., Tamayo, E., Resino, S., Group of Biomedical Research in Critical Care Medicine (BioCritic) (2018). Epidemiological trends of sepsis in the twenty-first century (2000-2013): an analysis of incidence, mortality, and associated costs in Spain. Population health metrics, 16(1), 4.

[2] Amland, R. C., & Sutariya, B. B. (2018). Quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and St. John Sepsis Surveillance Agent to detect patients at risk of sepsis: an observational cohort study. American Journal of Medical Quality, 33(1), 50-57.

[3] Andaluz, D., & Ferrer, R. (2017). SIRS, qSOFA, and organ failure for assessing sepsis at the emergency department. Journal of thoracic disease, 9(6), 1459.‏

[4] Carvas, J. M., Canelas, C., Montanha, G., Silva, C., & Esteves, F. (2016). Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department. Acta medica portuguesa, 29(2), 88-94.‏

[5] Dellinger, R. P., & Hussain, S. (2017). From Barcelona to New York: 15 years of transition of sepsis performance improvement. Journal of thoracic disease, 9(10), 3453.‏

[6] Dellinger, R. P., & Hussain, S. (2017). From Barcelona to New York: 15 years of transition of sepsis performance improvement. Journal of thoracic disease, 9(10), 3453.‏

[7] Farrell, C., & Casserly, B. (2018). Sepsis, the earlier the better, 3-to 1-hour bundle. Journal of Emergency and Critical Care Medicine, 2.‏

[8] Garnacho‑Montero J, Gutiérrez‑Pizarraya A, Escoresca‑Ortega A et al (2013) De‑escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock. Intensive Care Med 40(1):32‑40. doi:10.1007/s00134‑013‑3077‑7

[9] Gasim, G. I., Musa, I. R., Yassin, T., Al Shobaili, H. A., & Adam, I. (2016). Sepsis in Buraidah Central Hospital, Qassim, Kingdom of Saudi Arabia. International journal of health sciences, 10(2), 175-81.

[10] Gotts, J.E., & Matthay, M.A. (2016). Sepsis: Pathophysiology and clinical management. British Medical Journal, 353. https//doi: 10.1136/bmj. i1585

[11] Gül, F., Arslantaş, M. K., Cinel, İ., & Kumar, A. (2017). Changing definitions of sepsis. Turkish journal of anaesthesiology and reanimation, 45(3), 129.‏

[12] Gyawali, B., Ramakrishna, K., & Dhamoon, A. S. (2019). Sepsis: The evolution in definition, pathophysiology, and management. SAGE open medicine, 7, 2050312119835043.‏

[13] Institute for Healthcare Improvement. (2017). Timing of antibiotics. Retrieved from http://www.ihi.org/resources/Pages/Measures/TimingofAntibiotics.aspx

[14] Kaplan, L. J. (2015). Systemic Inflammatory Response Syndrome. Retrieved from emedicine.medscape.com/article/168943-overview

[15] Kim, M., Watase, T., Jablonowski, K. D., Gatewood, M. O., & Henning, D. J. (2017). A Sepsis-related Diagnosis Impacts Interventions and Predicts Outcomes for Emergency Patients with Severe Sepsis. Western Journal of Emergency Medicine, 18(6), 1098.‏

[16] Kleinpell, R. (2017). Promoting early identification of sepsis in hospitalized patients with nurse-led protocols.‏

[17] Kleinpell, R. M., Schorr, C. A., & Balk, R. A. (2016). The new sepsis definitions: implications for critical care practitioners. American Journal of Critical Care, 25(5), 457-464.‏

[18] Kleinpell, R., Blot, S., Boulanger, C., Fulbrook, P., & Blackwood, B. (2019). International critical care nursing considerations and quality indicators for the 2017 surviving sepsis campaign guidelines. Intensive care medicine, 45(11), 1663-1666.‏

[19] Kumar A (2016) Systematic bias in meta-analyses of time to antimicrobial in sepsis studies. Crit Care Med 44: e234–e235.

[20]    Le Conte, P., Thibergien, S., Obellianne, J. B., Montassier, E., Potel, G., Roy, P. M., & Batard, E. (2017). Recognition and treatment of severe sepsis in the emergency department: retrospective study in two French teaching hospitals. BMC emergency medicine, 17(1), 27.‏

[21]    Lester, D., Hartjes, T., & Bennett, A. (2018). CE: A Review of the Revised Sepsis Care Bundles. AJN The American Journal of Nursing, 118(8), 40-49.‏

[22]    Levy, M. M., Evans, L. E., & Rhodes, A. (2018). The surviving sepsis campaign bundle: 2018 update. Intensive care medicine, 44(6), 925-928.‏

[23]    Lindo, M. M. (2017). Evaluation of Automated Reminders to Reduce Sepsis Mortality Rates.‏

[24]    Machado, F. R., Ferreira, E. M., Schippers, P., de Paula, I. C., Saes, L., de Oliveira, F. I., Tuma, P., Nogueira Filho, W., Piza, F., Guare, S., Mangini, C., Guth, G. Z., Azevedo, L., Freitas, F., do Amaral, J., Mansur, N. S., Salomão, R., SPDM against sepsis project (2017). Implementation of sepsis bundles in public hospitals in Brazil: a prospective study with heterogeneous results. Critical care (London, England), 21(1), 268. doi:10.1186/s13054-017-1858-z.

[25]    Maclay, T., & Rephann, A. (2017). The impact of early identification and a critical care–based sepsis response team on sepsis outcomes. Critical care nurse, 37(6), 88-91.‏

[26]    Mayr, F. B., Yende, S., & Angus, D. C. (2014). Epidemiology of severe sepsis. Virulence, 5(1), 4-11.‏

[27]    McColl, T., Gatien, M., Calder, L., Yadav, K., et al. (2016). Implementation of an Emergency Department Sepsis Bundle and System Redesign: A Process Improvement Initiative. JCMU, 0(0), 1-10.

[28]    Meade, C. (2018). Intensive Care Unit Nurse Education to Reduce Sepsis Mortality Rates.‏

[29]    Memon, J. I., Rehmani, R. S., Alaithan, A. M., El Gammal, A., Lone, T. M., Ghorab, K., & Abdulbasir, A. (2012). Impact of 6-hour sepsis resuscitation bundle compliance on hospital mortality in a Saudi hospital. Critical care research and practice, 2012.‏

[30]    Milano, P. K., Desai, S. A., Eiting, E. A., Hofmann, E. F., Lam, C. N., Menchine, M. (2018). Sepsis Bundle Adherence Is Associated with Improved Survival in Severe Sepsis or Septic Shock. Western Journal of Emergency Medicine, 19(5), 774.‏

[31]    Neviere, R., Parsons, P. E., & Finlay, G. (2017). Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis. Monografía en Internet]. Wolters Kluwer: UpToDate.‏

[32]    Postelnicu, R., & Evans, L. (2017). Monitoring of the physical exam in sepsis. Current Opinion in Critical Care,23(3), 232-236. doi:10.1097/mcc.0000000000000403

[33]    Prasad, P. A., Shea, E. R., Shiboski, S., Sullivan, M. C., Gonzales, R., & Shimabukuro, D. (2017). Relationship between a sepsis intervention bundle and in-hospital mortality among hospitalized patients: a retrospective analysis of real-world data. Anesthesia & Analgesia, 125(2), 507-513.‏

[34]    Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., ... & Rochwerg, B. (2017). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive care medicine, 43(3), 304-377.‏

[35]    Rhodes, A., Phillips, G., Beale, R., Cecconi, M., Chiche, J. D., De Backer, D., Girardis, M. (2015). The surviving sepsis campaign bundles and outcome: Results from the International Multicenter Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Medicine, 41(9), 1620-1628.

[36]    Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., ... & Hotchkiss, R. S. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama, 315(8), 801-810.‏

[37]    Tulli, G. (2019). Diagnosis and Management of Sepsis and Septic Shock: An Evidence-Based Review. In Practical Trends in Anesthesia and Intensive Care 2018 (pp. 137-178). Springer, Cham.‏

[38]    van Vught LA, Klein Klouwenberg PM, Spitoni C, et al. Incidence, risk factors, and attributable mortality of secondary infections in the intensive care unit after admission for sepsis. JAMA. 2016;315(14):1469-1479.

[39] Walsh, J. (2017)