A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital

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 i...

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Autores principales:	Daniela Nasu Monteiro Medeiros, Ana Carolina Cintra Nunes Mafra, Joseph Anthony Carcillo, Eduardo Juan Troster
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	sepsis protocol emergence care mortality pediatrics children Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/eab2a534dbf14b4fa986e70ba7d9e6c4
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spelling	oai:doaj.org-article:eab2a534dbf14b4fa986e70ba7d9e6c42021-11-12T15:38:09ZA Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital2296-236010.3389/fped.2021.757721https://doaj.org/article/eab2a534dbf14b4fa986e70ba7d9e6c42021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.757721/fullhttps://doaj.org/toc/2296-2360Introduction: 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.Daniela Nasu Monteiro MedeirosAna Carolina Cintra Nunes MafraJoseph Anthony CarcilloEduardo Juan TrosterFrontiers Media S.A.articlesepsisprotocolemergence caremortalitypediatricschildrenPediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	sepsis protocol emergence care mortality pediatrics children Pediatrics RJ1-570
spellingShingle	sepsis protocol emergence care mortality pediatrics children Pediatrics RJ1-570 Daniela Nasu Monteiro Medeiros Ana Carolina Cintra Nunes Mafra Joseph Anthony Carcillo Eduardo Juan Troster A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital
description	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.
format	article
author	Daniela Nasu Monteiro Medeiros Ana Carolina Cintra Nunes Mafra Joseph Anthony Carcillo Eduardo Juan Troster
author_facet	Daniela Nasu Monteiro Medeiros Ana Carolina Cintra Nunes Mafra Joseph Anthony Carcillo Eduardo Juan Troster
author_sort	Daniela Nasu Monteiro Medeiros
title	A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital
title_short	A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital
title_full	A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital
title_fullStr	A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital
title_full_unstemmed	A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital
title_sort	pediatric sepsis protocol reduced mortality and dysfunctions in a brazilian public hospital
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/eab2a534dbf14b4fa986e70ba7d9e6c4
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A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital

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