Análisis descriptivo de la aplicación correcta y su impacto en la mortalidad del "hour-1 bundle" en los pacientes con sepsis y shock séptico atendidos en urgencias e ingresados en la unidad de cuidados intensivos

Abstract

La sepsis es un trastorno orgánico potencialmente mortal causado por la respuesta desregulada del huésped a la infección, con un pronóstico tiempo-dependiente. Un papel fundamental es la sospecha por parte del personal sanitario para establecer un diagnóstico y, consecuentemente, un tratamiento precoz. Las recomendaciones actuales de prácticas clínicas con el objetivo de disminuir la mortalidad en un 25%, dentro de la iniciativa internacional ¿Surviving Sepsis Campaign¿ se actualizan periódicamente desde 2004. En su última versión, de 2018 se hace especial mención a la correcta administración de las medidas terapéuticas en la primera hora desde el contacto del paciente con el servicio sanitario. En este proyecto describiremos el grado de cumplimiento de estas recomendaciones en los pacientes con sepsis y shock séptico e ingresados en la Unidad de Cuidados Intensivos de nuestro hospital. RESULTADOS: la aplicación de las medidas de la primera hora es: medida del lactato sérico 91% (71/78 pacientes); obtención de hemocultivos 62,33% (49/78 pacientes) y 81,81% si consideramos Tª >37,5º; administración de antibióticos 58,44% (45/78 pacientes), administración de fluidoterapia 68,83% (58/78 pacientes) y 66,66% si TAM < 65 y lactato >2; la administración de vasopresores si hipotensión refractaria a fluidoterapia intensiva es 7,69%.

Sepsis is a life-threatening organic disorder caused by the dysregulated host response to infection, with a time-dependent prognosis. A fundamental role is the suspicion by health personnel to establish a diagnosis and, consequently, early treatment. The current recommendations of clinical practices with the aim of reducing mortality by 25%, within the international initiative “Surviving Sepsis Campaign” have been periodically updated since 2004. In its latest version in 2018, special mention is made of the correct administration of therapeutic measures in the first hour from the patient’s contact with the health service. In this project we will describe the degree of compliance with these recommendations in patients with sepsis and septic shock and admitted to the Intensive Care Units of our hospital. METHODS: 78 patients over 18 years of age coming from the Emergency Department and admitted to the Intensive Care Unit of the General Hospital of Elche, during successive annual quarterly cuts in the Intensive Care Unit of the General University Hospital of Elche (from April 1 to June 30) of the years 2016-2017-2018-2019 of the national multicenter registry ENVIN-HELICS. Administrative, sociodemographic, biological and health variables of the patients were collected by reviewing the medical records. In the same way, the data collection of the application of the “hour-1 bundle” of sepsis was carried out. For the statistical analysis, the proportions for the categorical and median variables were calculated, with 25th and 75th percentiles in the case of continuous variables. RESULTS: in the retrospective analysis of “hour-1 bundle” of sepsis in the period 2016-2019 in the Emergency Department, the most implemented were those of a diagnostic nature: measurement of serum lactate 91% (71/78 patients); followed by obtaining blood cultures 62.33% (49/78 patients) and 81.81% if we consider temperature> 37.5º. Therapeutic measures were implemented to a lesser degree: administration of intensive fluid therapy in patients with TAM <65mmHg and lactate> 2 mmol / L (66.6%) and antibiotics (58.44%). Compliance with the administration of vasopressors in cases of hypotension refractory to intensive fluid therapy was low (7.69%). CONCLUSIONS: The measures of the first hour to improve are the administration of antibiotic therapy and intensive fluid therapy correctly. These therapeutic measures are keys in improving the prognosis of septic patients