Sepsis resuscitation guideline implementation in the department of emergency medicine, Siriraj hospital

Background: Sepsis management guidelines have been implemented in the Emergency Department, Siriraj Hospital since 2005. Objective: Assess the impact of sepsis resuscitation guidelines on the mortality of patients after implementation. Material and Method: A prospective cohort study was conducted in the Emergency Department, Siriraj Hospital between January 12 and October 2, 2011. Patients aged older than 18 years old were included. The baseline data and the extent of goal achievement were recorded. The primary outcome was the 30-day mortality rate. Results: One hundred forty four patients (34% severe sepsis, 66% septic shock) were included. The overall 30-day mortality was 39.6%. Antibiotics were administered within 1 hour in 52.2% of the patients. At least 1 or at least 2 therapeutic goals were accomplished in 86.8% and 50.7% of patients, respectively, and the achievement of at least 2 goals was associated with lower mortality (adjusted OR 0.41, 95% CI 0.19-0.89). Two patients (1.4%) completely achieved goals within 6 hours. Respiratory failure requiring endotracheal tube insertion was associated with higher mortality (adjusted OR 3.12, 95% CI 1.32-7.38). Conclusion: The 30-day mortality was 39.6%. The achievement of at least 2 goals was associated with lower mortality. Endotracheal tube insertion was associated with higher mortality.