Outcome of septic shock in older adults after implementation of the sepsis "bundle"

OBJECTIVES: To evaluate the effect on 28-day mortality of implementation of a sepsis "bundle" protocol for the treatment of older adults with septic shock. DESIGN: Observational prospective study with a historical control group. SETTING: Tertiary care center. PARTICIPANTS: Eighty-seven consecutive patients recruited between May 2004 and February 2007 matched to a historic group identified between March 2001 and April 2004. INTERVENTIONS: Implementation of a sepsis protocol for the management of septic shock. RESULTS: Subjects who were treated according to the sepsis "bundle" had an absolute risk reduction in 28-day mortality of 16% (95% confidence interval (CI)=-31% to -2%). The treatment group received a larger volume of fluid in the first 6 hours of presentation (3,960 +/- 1,990 vs 2,490 +/- 1,020 mL; P<.001) and lower doses of vasopressors (maximum dosage of norepinephrine 0.51 mu g/kg per min (range 0.12-1.7) vs 0.98 mu g/kg per min (range 0.15-3.1) P=.009). A high prevalence of adrenal insufficiency (86%) was identified in the study population. There were no significant differences between the treatment and control groups in the surviving patients with respect to duration of mechanical ventilation (median 8.5 vs 12.0, respectively; P=.07) or intensive care unit length of stay (median 12 days vs 15 days; P=.08). According to Cox regression analysis, implementation of the sepsis bundle protocol was independently associated with better 28-day survival (hazard ratio=0.54, 95% CI=0.33-0.86; P=.01). CONCLUSION: Older patients with septic shock had a better 28-day survival rate when treated with a comprehensive sepsis "bundle" protocol.