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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