EFFECT OF THE 'SURVIVING SEPSIS CAMPAIGN 2012' ON MORTALITY IN THE PEDIATRIC DEPARTMENT OF SIRIRAJ HOSPITAL

摘要

In 2012, Siriraj Hospital launched the "Surviving Sepsis Campaign 2012". The aim of this study was to evaluate guideline adherence and patient outcome after implementation and to investigate the factors that significantly associate with risk of morality in this illness. Patients aged 1 month to 15 years who were admitted for severe sepsis and septic shock during the 1 January 2013 to 31 December 2014 study period was enrolled. There were 48 children included. The year 1 and year 2 groups consisted of 23 and 25 patients, respectively. Most patients had comorbidities, and the main underlying disease was hemato-oncology. The most common primary site of infection was blood stream infection (43%) in year 1 and pneumonia (52.5%) in year 2. Most patients were intubated and on mechanical ventilation. After guideline promotion, completion of early goal-directed therapy significantly increased from 17.4% in year 1 to 72% in year 2. When we compared the mortality data from this study to the data collected a few years prior to guideline implementation, the mortality rate significantly decreased from 37.7% to 10.4% (p=0.001). Risk factors that were found to significantly affect mortality outcome were disseminated intravascular coagulation (p=0.04) and acute renal failure (p=0.001). Other risk factors for mortality were low serum albumin, neutropenia, ScvO(2) at 6 hours 70%, and higher maximal peak inspiratory pressure (p=0.024, p=0.017, p=0.01, and p=0.003, respectively). From these findings, we conclude that the 'Surviving Sepsis Campaign 2012' guideline has improved the outcome of severe sepsis and septic shock in children.