Format

Send to

Choose Destination
Chest. 2018 Aug;154(2):302-308. doi: 10.1016/j.chest.2018.03.025. Epub 2018 May 24.

Implications of Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Early Management Bundle and Initial Lactate Measurement on the Management of Sepsis.

Author information

1
Department of Medicine, University of Chicago, Chicago, IL.
2
Department of Medicine, University of Chicago, Chicago, IL; Center for Healthcare Delivery Science and Innovation, Chicago, IL.
3
Department of Medicine, University of Michigan Hospital, Ann Arbor, MI.
4
Department of Pharmacy, University of Chicago, Chicago, IL.
5
Center for Quality, University of Chicago, Chicago, IL.
6
Google, Mountain View, CA.
7
Department of Medicine, University of Chicago, Chicago, IL; Center for Healthcare Delivery Science and Innovation, Chicago, IL. Electronic address: matthew.churpek@uchospitals.edu.

Abstract

BACKGROUND:

Sepsis remains a significant cause of morbidity and mortality in the United States, leading to the implementation of the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1). SEP-1 identifies patients with "severe sepsis" via clinical and laboratory criteria and mandates interventions, including lactate draws and antibiotics, within a specific time window. We sought to characterize the patients affected and to study the implications of SEP-1 on patient care and outcomes.

METHODS:

All adults admitted to the University of Chicago from November 2008 to January 2016 were eligible. Modified SEP-1 criteria were used to identify appropriate patients. Time to lactate draw and antibiotic and IV fluid administration were calculated. In-hospital mortality was examined.

RESULTS:

Lactates were measured within the mandated window 32% of the time on the ward (n = 505) compared with 55% (n = 818) in the ICU and 79% (n = 2,144) in the ED. Patients with delayed lactate measurements demonstrated the highest in-hospital mortality at 29%, with increased time to antibiotic administration (median time, 3.9 vs 2.0 h). Patients with initial lactates > 2.0 mmol/L demonstrated an increase in the odds of death with hourly delay in lactate measurement (OR, 1.02; 95% CI, 1.0003-1.05; P = .04).

CONCLUSIONS:

Delays in lactate measurement are associated with delayed antibiotics and increased mortality in patients with initial intermediate or elevated lactate levels. Systematic early lactate measurement for all patients with sepsis will lead to a significant increase in lactate draws that may prompt more rapid physician intervention for patients with abnormal initial values.

KEYWORDS:

critical care; lactic acid; sepsis; septic shock

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center