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J Crit Care. 2017 Oct;41:222-228. doi: 10.1016/j.jcrc.2017.05.024. Epub 2017 May 27.

Treatment outcomes after implementation of an adapted WHO protocol for severe sepsis and septic shock in Haiti.

Author information

1
Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: apapali@som.umaryland.edu.
2
Division of Pulmonary & Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA; International Respiratory and Severe Illness Center, University of Washington School of Medicine, Seattle, WA, USA.
3
Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
4
Department of Medicine, St. Luke Family Hospital, Port-au-Prince, Haiti.
5
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
6
Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Abstract

PURPOSE:

The World Health Organization (WHO) has developed a simplified algorithm specific to resource-limited settings for the treatment of severe sepsis emphasizing early fluids and antibiotics. However, this protocol's clinical effectiveness is unknown. We describe patient outcomes before and after implementation of an adapted WHO severe sepsis protocol at a community hospital in Haiti.

MATERIALS AND METHODS:

Using a before-and-after study design, we retrospectively enrolled 99 adult Emergency Department patients with severe sepsis from January through March 2012. After protocol implementation in January 2014, we compared outcomes to 67 patients with severe sepsis retrospectively enrolled from February to April 2014. We defined sepsis according to the WHO's Integrated Management of Adult Illness guidelines and severe sepsis as sepsis plus organ dysfunction.

RESULTS:

After protocol implementation, quantity of fluid administered increased and the physician's differential diagnoses more often included sepsis. Patients were more likely to have follow-up vital signs taken sooner, a radiograph performed, and a lactic acid tested. There were no improvements in mortality, time to fluids or antimicrobials.

CONCLUSIONS:

Use of a simplified sepsis protocol based primarily on physiologic parameters allows for substantial improvements in process measures in the care of severely septic patients in a resource-constrained setting.

KEYWORDS:

Critical care; Haiti; Intensive care; Resource-limited; Sepsis; World Health Organization

PMID:
28591678
DOI:
10.1016/j.jcrc.2017.05.024
[Indexed for MEDLINE]

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