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BMJ. 2011 Jun 13;342:d3245. doi: 10.1136/bmj.d3245.

Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study.

Collaborators (161)

Zhang XY, Shrestha BM, Diab A, Lin MC, Hameed AA, Aziz L, Fatema K, Huda AK, Faruk M, Faruq MO, Hossain MH, Khatun UH, Mannan MA, Ahsan AS, Tamanna RJ, Islam MS, Ahmed F, Maniruzzaman M, Wahab AY, Yan CL, Mi YH, Xu Y, Yi L, Li ZX, Wan XY, Wang X, Shi SJ, Wang SH, Gu JX, Xu P, Zhang GX, Hu YY, Chen Z, Han XD, Du B, Liu YH, Duan Y, Chen DC, Ma SL, Yu KL, Song XH, Cao TW, Shen J, Qu P, Zhang XY, Chen HS, Huang XB, Fu JH, Tang JG, Qian CY, Sun SZ, Xu HY, Jiang DH, Wang SY, Huang WD, Liang QM, Sun RH, Lu XM, Li JG, Zhu DM, Chow FL, Cheng C, Shum HP, Gomersall C, Leung A, Young K, Todi S, Mani AK, Abraham BK, Ramakrishnan N, Govil D, Samavedam S, Rao SV, Jog S, Iyer SK, Bande BD, Sahu S, Tipparaju SS, Chatterjee S, Kapadia F, Kulkarni S, Jani CK, Patel MH, Shastri P, Saikia S, Amin N, Divatia J, Hanafie A, Manalu R, Wahjuprajitno B, Sunartomo T, Arif SK, Suranadi IW, Sedono R, Nishimura M, Othman AS, Tai LL, Mohd Noor MR, Alias A, Lim CH, Tan CC, Ratnam S, Abdul Shukor A, Tong JM, Abdul Rahman R, Shrestha BR, Maharjan SK, Salahuddin N, Ahmed Z, Noor A, Al-Dorzi H, Arabi YM, Al Azem A, Qushmaq I, Mandourah Y, Johan A, Chia N, Tee A, Tham HM, Agrawal D, Tan AY, Chan KP, Soh CR, Ho BC, Loo S, Lee YJ, Koh Y, Hong SK, Kim KC, Lee MG, Kim JY, Lee KM, Chon GR, Park HS, Um SJ, Choi HS, Lee JH, Jung KS, Kim TH, Lee SS, Cho JH, Lee KM, Lim CH, Kim JH, Choi JE, Kim YS, Kim SC, Koh SO, Park MS, Seo KW, Lee WY, Sei Hoon SH, Fang WF, Huang KT, Nguyen GB, Dao XC, Nguyen DT, Pham TN, Phan TX, Truong NH, Tran TC.



To assess the compliance of Asian intensive care units and hospitals to the Surviving Sepsis Campaign's resuscitation and management bundles. Secondary objectives were to evaluate the impact of compliance on mortality and the organisational characteristics of hospitals that were associated with higher compliance.


Prospective cohort study.


150 intensive care units in 16 Asian countries.


1285 adult patients with severe sepsis admitted to these intensive care units in July 2009. The organisational characteristics of participating centres, the patients' baseline characteristics, the achievement of targets within the resuscitation and management bundles, and outcome data were recorded.


Compliance with the Surviving Sepsis Campaign's resuscitation (six hours) and management (24 hours) bundles.


Hospital mortality was 44.5% (572/1285). Compliance rates for the resuscitation and management bundles were 7.6% (98/1285) and 3.5% (45/1285), respectively. On logistic regression analysis, compliance with the following bundle targets independently predicted decreased mortality: blood cultures (achieved in 803/1285; 62.5%, 95% confidence interval 59.8% to 65.1%), broad spectrum antibiotics (achieved in 821/1285; 63.9%, 61.3% to 66.5%), and central venous pressure (achieved in 345/870; 39.7%, 36.4% to 42.9%). High income countries, university hospitals, intensive care units with an accredited fellowship programme, and surgical intensive care units were more likely to be compliant with the resuscitation bundle.


While mortality from severe sepsis is high, compliance with resuscitation and management bundles is generally poor in much of Asia. As the centres included in this study might not be fully representative, achievement rates reported might overestimate the true degree of compliance with recommended care and should be interpreted with caution. Achievement of targets for blood cultures, antibiotics, and central venous pressure was independently associated with improved survival.

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