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Table 2 Sepsis-related interventions during the treatment period for patients with sepsis or septic shock in the three study phases: pre-intervention (A), intervention phase I (B) and intervention phase II (C)

From: The impact of a multifaceted intervention including sepsis electronic alert system and sepsis response team on the outcomes of patients with sepsis and septic shock

Variable Pre-intervention
A
Intervention phase I
B
Intervention phase II
C
p value p value after propensity scores adjustments
All patients N = 436 N = 195 N = 699 B vs. A C vs. B C vs. A B vs. A C vs. B C vs. A
Lactate measured at any time, no. (%) 406 (93.1) 191 (97.9) 682 (97.6) 0.01 1.0 0.0003 0.02 0.72 0.009
Time to lactate (h), mean ± SD 9.3 ± 22.1 2.5 ± 5.3 1.1 ± 3.7 <0.0001 0.0008 <0.0001 0.002 0.0002 <0.0001
Lactate (mmol/L), mean ± SD 3.9 ± 3.6 3.3 ± 2.3 3.4 ± 5.5 0.01 0.93 0.03 0.76 0.28 0.26
Measure lactate within 6 h, no. (%) 270 (61.9) 168 (86.2) 663 (94.9) <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001
Blood culture obtained at any time, no. (%)a 238 (54.6) 119/194 (61.3) 592/679 (87.2) 0.11 <0.0001 <0.0001 0.16 <0.0001 <0.0001
Time to blood culture (h), mean ± SD 2.4 ± 6.7 0.9 ± 1.4 0.9 ± 2.5 0.001 0.94 0.0008 0.02 0.84 0.0001
Blood culture before antibiotics, no. (%) 219 (50.2) 116 (59.5) 565 (80.8) 0.02 <0.0001 <0.0001 0.10 <0.0001 <0.0001
Antibiotics administered at any time, no. (%)a 266/269 (98.9) 136/137 (99.3) 439/448 (98.0) 1.0 0.47 0.55 0.97 0.45 0.87
Time to antibiotic administration (h), mean ± SD 4.8 ± 6.7 3.0 ± 3.6 1.9 ± 3.3 0.0004 0.002 <0.0001 0.002 0.002 0.01
Antibiotics within 3 h, no. (%) 295 (67.7) 149 (76.4) 625 (89.4) <0.0001 <0.0001 <0.0001 0.01 0.0001 <0.0001
Patients with hypotension/lactate >4 mmol/L N = 406 N = 149 N = 361       
Fluids delivered at any time, no. (%)a 399 (98.3) 148 (99.3) 344 (95.3) 0.69 0.02 0.02 0.51 0.15 0.51
MAP raised and remained >65 mmHg, no. (%) 88/399 (22.1) 53/148 (35.8) 229/344 (67.8) 0.001 <0.0001 <0.0001 0.02 0.50 0.09
Vasopressors administered, no. (%) 299/311 (96.1) 91/95 (95.8) 101/115 (87.8) 1.0 0.04 0.002 0.72 0.07 0.05
Fluids (≥20 mL/kg) and vasopressors in the first 6 h, no. (%) 364/412 (88.4) 144/153 (94.1) 324/370 (87.6) 0.04 0.03 0.74 0.04 0.08 0.85
Compliance with the 4 elements bundle 84 (19.3) 87 (44.6) 485 (69.4) <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001
Patients with persistent hypotension/lactate >4 mmol/L N = 333 N = 115 N = 209       
CVP ≥ 8 mmHg achieved, no. (%)
 Within 6 h 71/358 (19.8) 24/121 (19.8) 64/245 (26.1) 0.99 0.18 0.07 0.47 0.0002 <0.0001
 Within 24 h 190 (57.2) 51 (44.4) 98 (46.9) 0.002 0.69 <0.0001 0.06 0.004 0.66
 After 24 h 42 (12.7) 6 (5.2) 7 (3.4)       
 Time to CVP (h), mean ± SD 16.3 ± 21.8 11.3 ± 10.4 8.1 ± 9.5 0.01 0.05 <0.0001 0.25 0.02 0.005
ScvO2 ≥ 70% achieved, no. (%)
 Within 6 h 65/358 (18.2) 19/121 (15.7) 56/245 (22.9) 0.53 0.11 0.16 0.69 <0.0001 0.0006
 Within 24 h 106 (31.9) 26 (22.6) 78 (37.3) 0.03 0.57 0.006 0.003 <0.0001 0.31
 After 24 h 37 (11.1) 5 (4.4) 7 (3.6)       
 Time to ScvO2 (h) mean ± SD 20.8 ± 52.1 9.8 ± 13.7 8.2 ± 12.7 <0.0001 <0.0001 <0.0001 0.41 0.40 0.09
  1. aPatients who had cultures or received antibiotics prior to meeting sepsis and septic shock criteria were not included
  2. a20 mL/kg of crystalloid fluids CVP central venous pressure, MAP mean arterial pressure, ScvO 2 central venous oxygen saturation. Denominators are equal to ‘N’ in all three phases unless otherwise specified