Treatment outcomes after implementation of an adapted WHO protocol for severe sepsis and septic shock in Haiti

The World Health Organization (WHO) has developed a simplified algorithm specific to resource-limited settings for the treatment of severe sepsis emphasizing early fluids and antibiotics. However, this protocol's clinical effectiveness is unknown. We describe patient outcomes before and after i...

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Bibliographic Details
Published in:Journal of critical care Vol. 41; pp. 222 - 228
Main Authors: Papali, Alfred, Eoin West, T., Verceles, Avelino C., Augustin, Marc E., Nathalie Colas, L., Jean-Francois, Carl H., Patel, Devang M., Todd, Nevins W., McCurdy, Michael T.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.10.2017
Elsevier Limited
Subjects:
Adult
Aged
Algorithms
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antimicrobial agents
Benchmarking
Clinical outcomes
Clinical Protocols
Critical Care
Drug Administration Schedule
Emergency medical care
Emergency Service, Hospital - organization & administration
Emergency Service, Hospital - standards
Female
Fluids
Haiti
Hospital Mortality
Hospitals
Humans
Infection Control
Intensive care
Laboratories
Malaria
Male
Middle Aged
Mortality
Outcome Assessment (Health Care)
Patients
Practice Guidelines as Topic
Resource-limited
Retrospective Studies
Sepsis
Sepsis - mortality
Sepsis - prevention & control
Shock, Septic - mortality
Shock, Septic - prevention & control
Trauma
Treatment Outcome
Tropical diseases
Ultrasonic imaging
Vital signs
World Health Organization
Haiti
United States > US
Port Au Prince Haiti
Critical care
Haiti
Sepsis
Intensive care
World Health Organization
Resource-limited
ISSN:0883-9441, 1557-8615, 1557-8615
Online Access:Get full text
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Description
Summary:The World Health Organization (WHO) has developed a simplified algorithm specific to resource-limited settings for the treatment of severe sepsis emphasizing early fluids and antibiotics. However, this protocol's clinical effectiveness is unknown. We describe patient outcomes before and after implementation of an adapted WHO severe sepsis protocol at a community hospital in Haiti. Using a before-and-after study design, we retrospectively enrolled 99 adult Emergency Department patients with severe sepsis from January through March 2012. After protocol implementation in January 2014, we compared outcomes to 67 patients with severe sepsis retrospectively enrolled from February to April 2014. We defined sepsis according to the WHO's Integrated Management of Adult Illness guidelines and severe sepsis as sepsis plus organ dysfunction. After protocol implementation, quantity of fluid administered increased and the physician's differential diagnoses more often included sepsis. Patients were more likely to have follow-up vital signs taken sooner, a radiograph performed, and a lactic acid tested. There were no improvements in mortality, time to fluids or antimicrobials. Use of a simplified sepsis protocol based primarily on physiologic parameters allows for substantial improvements in process measures in the care of severely septic patients in a resource-constrained setting. •The WHO’s severe sepsis algorithm emphasizes early fluids and antibiotics.•However, this protocol’s clinical efficacy in a real-world setting is unknown.•We describe patient outcomes after implementation of an adapted WHO severe sepsis protocol in Haiti.•Post-protocol, quantity of fluids given increased and the physician’s differential diagnoses more often included sepsis.•Post-protocol patients had follow-up vital signs taken sooner, a radiograph performed, and a lactic acid tested.•There were no improvements in mortality, time from triage to fluids or antimicrobials.
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ISSN:0883-9441
1557-8615
1557-8615
DOI:10.1016/j.jcrc.2017.05.024