A “three delays” model for severe sepsis in resource-limited countries

The developing world carries the greatest burden of sepsis-related mortality, but success in managing severe sepsis in resource-limited countries (RLCs) remains challenging. A “three delays” model has been developed to describe factors influencing perinatal mortality in developing nations. This mode...

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Bibliographic Details
Published in:Journal of critical care Vol. 30; no. 4; pp. 861.e9 - 861.e14
Main Authors: Papali, Alfred, McCurdy, Michael T., Calvello, Emilie J.B.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.08.2015
Elsevier Limited
Subjects:
Anti-Bacterial Agents - therapeutic use
Clinical Competence
Critical Care
Delayed Diagnosis - statistics & numerical data
Developing Countries
Developing country
Emergency medical care
Fluid Therapy - methods
Global health
Health Care Costs
Health education
Health Literacy
Health Resources
Health Services Accessibility
Hospitals
Humans
Industrialized nations
Intensive care
LDCs
Medicine
Models, Theoretical
Mortality
Nurses
Oxygen Inhalation Therapy - methods
Patients
Pediatrics
Physicians
Resource-limited
Resuscitation - statistics & numerical data
Risk Factors
Sepsis
Sepsis - diagnosis
Sepsis - mortality
Sepsis - therapy
Time Factors
Time-to-Treatment - statistics & numerical data
Triage
Uganda
North America
Critical care
Global health
Sepsis
Intensive care
Resource-limited
Developing country
ISSN:0883-9441, 1557-8615, 1557-8615
Online Access:Get full text
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Summary:The developing world carries the greatest burden of sepsis-related mortality, but success in managing severe sepsis in resource-limited countries (RLCs) remains challenging. A “three delays” model has been developed to describe factors influencing perinatal mortality in developing nations. This model has been validated across different World Health Organization regions and has provided the framework for policymakers to plan targeted interventions. Here, we propose a three delays model for severe sepsis in RLCs. A literature review was performed using the PubMed, Google Scholar, and Ovid databases. Additional sources were found after review of the reference lists from retrieved articles. We propose a three delays model for severe sepsis in adults in RLCs. The model highlights limitations in the 3 basic pillars of sepsis management: (1) sepsis recognition and diagnosis at the time of triage, (2) initial focused resuscitation, and (3) postresuscitation clinical monitoring and reassessment. Characterizing the major barriers to effective treatment of severe sepsis in RLCs frames the problem in a language common to global health circles, which may stimulate further research, streamline treatment, and reduce sepsis-related mortality in the developing world.
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ISSN:0883-9441
1557-8615
1557-8615
DOI:10.1016/j.jcrc.2015.04.003