Emergency department implementation of a severe sepsis code

Objective: To analyze the degree of compliance with a severe sepsis code and the achievement of hemodynamic goals under that code. Methods: Prospective observational study (October 2006 through March 2007) of patients meeting the following sets of inclusion criteria: 1) suspicion of infection; 2) temperature < 36 degrees C or >38 degrees C, or heart rate > 90 beats/min or respiratory rate > 20 breaths/min, or diminished level of consciousness; and 3) systolic blood pressure < 90 mm Hg, or mean arterial pressure < 70 mm Hg, or a decrease in blood pressure > 40 mm Hg in hypertensive individuals. We recorded clinical variables, degree of compliance with measures specified in the code in the first 6 hours, success in reaching hemodynamic goals, and hospital mortality. Results: The mean (SD) age was 58.4 (20) years and 70.7% were men. The respiratory tract was the most frequent focus of infection (in 50% of the cases). The code was implemented in 64.5% of the cases. In-hospital mortality was 17.5%. Regarding achievement of hemodynamic goals, a mean arterial pressure >= 65 mm Hg was reached in 77.5%, diuresis >= 0.5 mL/kg/h was observed in 82.5%, and a central venous pressure of 8 mm Hg to 12 mm Hg was reached in 45.4% and a central venous oxygen saturation (SvcO(2)) of >= 70% in 15.6%. The level of compliance with each stipulated measure was as follows: blood cultures before starting an antibiotic, 90%; administration of an antibiotic within 3 hours, 95.7%; measurement of lactate level, 97.5%; resuscitation with adequate volume, 80%; administration of noradrenalin, 80%; and measurement of central venous pressure and SvcO(2), in 72.7% and 31.2%, respectively. Conclusions: Implementing a severe sepsis code facilitated the achievement of consistent management of this condition. Emergency personnel were alert to detecting sepsis and treating it early, and they became aware of aspects of care that could be improved. [Emergencias 2009;21:255-261]