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 RESEARCH ARTICLE
Year : 2018  |  Volume : 22  |  Issue : 12  |  Page : 846--851

The utilization of the surviving sepsis campaign care bundles in the treatment of pediatric patients with severe sepsis or septic shock in a resource-limited environment: A prospective multicenter trial


1 Division of Pediatric Critical Care, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
2 Division of Pediatric Critical Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand
3 Division of Pediatric Critical Care, Ramathibodi Hospital, Bangkok, Thailand
4 Division of Pediatric Pulmonary and Critical Care, Khon Kaen University Hospital, Khon Kaen, Thailand
5 Division of Pediatric Pulmonary and Critcal care, Hat Yai Hospital, Songkhla Province, Thailand
6 Division of Pediatric Pulmonary and Critical Care, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
7 Division of Pediatric Pulmonary and Critical Care, Vachira Hospital, Bangkok, Thailand

Correspondence Address:
Prof. Rujipat Samransamruajkit
Division of Pediatric Critical Care, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijccm.IJCCM_367_18

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Background: Sepsis is a common condition affecting the lives of infants and children worldwide. Although implementation of the surviving sepsis campaign (SSC) care bundles was once believed to be effective in reducing sepsis mortality rates, the approach has recently been questioned. Methods: The study was a prospective, interventional, multicenter trial. Infants and children aged 1 month to 15 years in seven different large academic centers in Thailand who had been diagnosed with severe sepsis or septic shock. They were given treatment based on the SSC care bundles. Results: A total of 519 children with severe sepsis or septic shock were enrolled in the study. Among these, 188 were assigned to the intervention group and 331 were recruited to the historical case–control group. There were no significant differences in the baseline clinical characteristics. The intervention group was administered a significantly higher fluid bolus than was the control group (28.3 ± 17.2 cc/kg vs. 17.7 ± 10.6 cc/kg; P = 0.02) with early vasopressor used (1.5 ± 0.7 h) compared to control group (7.4 ± 2.4 h, P < 0.05). More importantly, our sepsis mortality reduced significantly from 37% ± 20.7% during the preintervention period to 19.4% ± 14.3% during the postintervention period (P < 0.001). Conclusion: Our study demonstrated a significant reduction in sepsis mortality after the implementation of the SSC care bundles. Early diagnosis of the disease, optimum hemodynamic resuscitation, and timely antibiotic administration are the key elements of sepsis management.






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