3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。noteもあります https://note.com/twin1980

Improved Outcomes After Regional Implementation of Sepsis Alert A Novel Triage Model

敗血症における抗菌薬投与タイミングについてのスウェーデン8施設からの報告。

 

journals.lww.com

 

 

感想

 

敗血症アラートによって、抗菌薬投与までの時間は、37minから26minに優位に短縮。

死亡率に差がないが、敗血症のバックグランド違うので精査を待ちたい。

 

敗血症アラートはシンプルな取り組みて良いと思いました。

 

 

Abstract

 

Objectives:

To assess whether the triage model Sepsis Alert for Emergency Departments results in improved initial care of patients with severe infections.

 

Design:

Interventional study comparing patient care before and after the start of a new triage model, including 90-day follow-up.

 

Setting:

Eight emergency departments in Skåne County, Sweden.

 

Subjects:

Patients with suspected severe infection.

 

Interventions:

Patients with severely deviating vital signs and suspected infection were triaged into a designated sepsis line called Sepsis Alert, for rapid evaluation supported by an infectious disease specialist. Also, all emergency department staff participated in a designated sepsis education before the model was introduced.

 

Measurements and Main Results:

 

Medical records were evaluated for a 3-month period 1 year before the triage system was started in 2016 and for a 3-month period 1 year after. Of 195,607 patients admitted to these emergency departments during two 3-month periods, a total of 5,321 patients presented severely abnormal vital signs. Of these, 1,066 patients who presented with fever greater thanor equal to 38°C or history of fever/chills were considered to be patients at risk of having severe sepsis. Among patients triaged according to Sepsis Alert, 89.3% received antibiotic treatment within 1 hour after arrival to the emergency department (median time to antibiotics, 26 min), which was significantly better than before the start of the new triage: 67.9% (median time to antibiotics, 37 min) (p < 0.001). Additionally, sepsis treatment quality markers were significantly improved after the introduction of Sepsis Alert, including number of blood cultures and lactate measurements taken, percentage of patients receiving IV fluids, and appropriate initial antibiotic treatment. There were no differences in 28- or 90-day mortality rates.

 

Conclusions:

 

The implementation of the new triage model Sepsis Alert with special attention to severe sepsis patients led to faster and more accurate antibiotic treatment and improved diagnostic procedures and supportive care.

 

 

ICU/CCUの薬の考え方、使い方 ver.2

ICU/CCUの薬の考え方、使い方 ver.2

  • 作者:大野 博司
  • 出版社/メーカー: 中外医学社
  • 発売日: 2015/12/25
  • メディア: 単行本(ソフトカバー)