Impacto da implantação de um protocolo clínico assistencial baseado na campanha de sobrevivência à sepse em uma UTI de um hospital público

Abstract

Introduction: Sepsis is a serious health problem that presents high morbidity and mortality rates and entails high treatment costs, present in both public and private hospital ICUs and in emergency units. The high mortality worldwide, has aroused the interest of experts in the field and health professionals in finding ways to decrease the number of deaths by septic syndrome. In 2002, a worldwide campaign was launched, a Sepsis Survival Campaign (SSC) led by experts from an international committee of three major medical societies (Society of Critical Care Medicine, European Society of Intensive Care Sepsis Medical and International Forum) with the scope of bundles of bedside interventions directed to the diagnosis and treatment of sepsis. A SSC constituted a global effort organized to decrease as high morbidity and mortality rates of sepsis by 25% over 5 years, through better initial handling of severe sepsis and septic shock. In Brazil, a SSC was implemented in 2005 by the Latin American Sepsis Institute (ILAS). ILAS is a not-for-profit non-governmental organization (NGO), responsible for conducting the Campaign in Brazil, providing assistance to institutions that are interested in implementing protocols for diagnosis and treatment of sepsis, based on SSC. Objective: Know the adherence of health professionals and mortality due to severe sepsis and septic shock, before and after the implementation of a managed care protocol, based on the guidelines of the Sepsis Survival Campaign. Material and methods: A before and after cohort study conducted in an Adult Intensive Care Unit of a public tertiary hospital. A total of 199 cases of sepsis were studied, of which 85 were in phase I and 114 in phase II, evaluating adherence to the three and six hour protocols of sepsis, age, sex, infectious focus, SAPS III, mortality/lethality, Organic dysfunction, diagnosis, length of stay in the ICU/hospital and outcome. Results: Adherence to the three- and six-hour packages in phase I was 10.6% and 3.5% and in phase II 9.7% and 6.1%. The mean ICU stay during phase I was 21.8 ± 18.2 and in phase II 25.0 ± 20.8 and hospital stay in phase I was 42.9 ± 31.5 and in phase II 44.2 ± 34.9. The mortality in phase I due to sepsis was 10.5%, severe sepsis 21.1% and septic shock 68.4% and in phase II sepsis was 7.8% severe sepsis 23.5% and septic shock 68, 6%. The septic shock lethality in the two phases was 44.7% and 47.4%. Conclusion: The study evidenced a low adherence to the sepsis protocol with a predominance of severe and advanced forms of the disease, contributing to the high mortality rate.