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 |