Studies on Sepsis Management and Care Pathways

This article provides a summary of various studies on sepsis management, care pathways, and clinical outcomes. The studies cover topics such as the sepsis six bundle, fluid bolus therapy, adherence to electronic guidelines, and more. The article also highlights the importance of early intervention and recognition of sepsis signs and symptoms.

Authors Objective Design Methodology Results Conclusion
Adcroft
(2014)
To
investigate
processes
for
management
of sepsis
patients in
AAU
Retrospecti
ve cohort
Audit
performed for
30 patients
diagnosed
with severe
sepsis and
septic shock,
followed by
assessment of
the notes, and
comparing
them against
figures of
emergency
department
Performance
below the
national
standards for
high flow
oxygen
administration,
crystalloid fluid
boluses, lactate
measurements,
and blood
culture
Low
standards of
sepsis
management
paved the
way for the
introduction
of sepsis six
management
bundle.
Educating
healthcare
professionals
, and
increasing
awareness on
sepsis
management
showed
significant
improvement
s in patients,
after re-
audit.

Burke et
al. (2019)
To explore
the impacts
of sepsis six
bundle
administrati
on on patient
outcomes
Prospectiv
e
observatio
nal study
Introduction
of sepsis bags
and sepsis six
bundle,
followed by
their
administration
to 207 patients
who had been
admitted for
sepsis
management
84% overall
bundle
compliance.
National Early
Warning Scores
reduced
considerably 24
hours, after
Sepsis Six
administration,
from 7⋅4 ±2⋅6 to
3⋅1 ±2⋅4 (p
<0⋅001).
Reduced
mortality at 90
days amid
patients who
received the
bundle, 48 hours
after admission
Better
patient
outcomes
obtained
after sepsis
six
administratio
n to patients.
Reliable
bundle
delivery was
80%
attainable,
notwithstand
ing similarity
in baseline
variables
Deep et
al. (2013)
To observe
evolution of
SVR and
CO during
intensive
Prospectiv
e
observatio
nal study
Use of non-
invasive
ultrasound
cardiac output
monitor
88.9% general
28-day survival.
Lower ScvO2 in
community-
acquired group,
Children
with
community-
acquired
septic shock

care
treatment of
children
suffering
from fluid-
refractory
septic shock
device
(USCOM) for
studying 36
children
admitted to
ICU for 36
months,
followed by
titration of
inotrope,
inodilator and
vasopressor
when compared
to hospital-
acquired group.
Normal CI and
SVRI reported
by children in
both groups,
within 42 hours
of therapy.
reported
signs and
symptoms of
cold shock.
However,
those who
were
categorised
to hospital-
acquired
septic shock
manifested
symptoms of
warm shock.
Survival
rates for 28
days were
same in both
the groups.
Hancock
(2015)
To
determine
the efficacy
of a national
quality
improvemen
Prospectiv
e
observatio
nal study
Clinical teams
contributed
in education s
ets at where
there were
provided
All organisations
were found to
implement
advanced
treatment tools
and procedures
Collaborativ
e learning
has been
identified as
an effective
procedure

t initiative,
in lowering
death rate
and harm
from sepsis
training in
service
development
and human
factors
philosophies,
followed by
providing
support in
order to
administer
‘bundles’
based on
evidences, for
assessing both
the treatment
procedures
and outcomes.
such as, NEWS,
Patient Status at
A Glance
(PSAG) boards,
sepsis screening
tools,
antibiotic formul
ary, and sepsis
response bags.
for
enhancing
quality of
sepsis
management
Inwald et
al. (2019)
To assess
feasibility of
Fluids in
Shock for
10 mL/kg
versus 20
mL/kg fluid
Randomise
d
controlled
trial
Random
allocation of
children with
sepsis to 10 or
20 mL/kg flui
d bolus in 1;1
ratio, for 15
Fluid bolus
volume was 44%
less after 4 hours
in 10 mL/kg
group. 2.1 and
2.0 Paediatric
Index of
Children did
not report
any
symptoms of
being
unwell.

bolus
volume
minutes, till 4
hours
Mortality-2
score was found
in 10 mL/kg and
20 mL/kg group,
respectively.
Kopczyns
ka et al.
(2015)
To explore
the efficacy
of Red Flag
sepsis
criteria for
identificatio
n of high
risk sepsis
patients,
compared to
SOFA based
sepsis
criteria.
Prevalence
study
459 patients
were recruited
from
emergency
departments
and general
wards over a
period of 24
hours,
followed by
collection of
NEWS score,
SIRS, and
qSOFA scores
246 patients
positive for Ref
Flag sepsis,
33.7% mortality,
241 for SOFA
with 39.4%
mortality, 268
for SIRS with
33.6% mortality,
and 54 for
qSOFA with
57.4% mortality
rates.
Association
established
between old age
and death,
increased frailty
score, and
ceiling of care
Subset of
population
at-risk were
captured by
a range of
clinical tools
having
similar
precision and
comparable
similarity for
presence of
confirmed
sepsis or
infection

Lat et al.
(2018)
To explore
different
ways of
sepsis
recognition
and clinical
management
among older
people
Secondary
research
Thorough and
comprehensiv
e search of
different
electronic
databases to
retrieve
scholarly
articles and
clinical
guidelines
QuickSOFA is
an effective
method of sepsis
recognition
based on altered
mental state,
blood pressure
100 mmHg, and
22 breath/minute
respiratory rate.
Treatment must
be done showing
adherence to the
Surviving Sepsis
Campaign that
covers
implementation
of the Sepsis Six
bundle
The life-
threatening
condition
can often
lead to death
or multiple
organ failure
among older
adults, if not
managed
properly.
Mouncey
et al.
(2015)
To
determine
effectiveness
of early,
goal-
directed
Pragmatic
randomize
d trial
Random
allocation of
1260 patients
to usual care
group or
EGDT group
29.5% and
29.2% patients
in EGDT and
usual care group,
respectively died
by 90 days.
Strict
adherence to
EGDT failed
to
demonstrate
any

therapy
(EGDT) for
sepsis
management
among
patients
reporting
early septic
shock
in 1:1 ratio,
followed by
determining
all-cause
mortality rate
after 90 days
Increase in
intensity of
treatment
observed in
EGDT group
due to increased
usage of
vasoactive
drugs,
intravenous
fluids and red
cell transfusion
significant
improvement
in health
outcomes
among sepsis
patients
Nguyen
et al.
(2012)
To evaluate
the clinical
outcomes
related to
sepsis
management
guideline
implementat
ion in
community
based
hospital
Observatio
nal cohort
study
Implementatio
n of quality
improvement
program that
comprised of
providing
sepsis
education,
based on the
recommendati
ons of sepsis
six campaign
among 96
Similar health
outcomes
obtained among
patients in
control group
and SSC group,
with comparable
ICU length of
stay. Similar
MV time
between the
patients, with
increased
Application
of the
campaign
guideline
through
education
program
proved
effective and
feasible, and
led to early
therapy of
patients with

patients survival
percentage
among those
who were treated
based on the
guidelines.
correct
antibiotics
and
aggressive
fluid
administratio
n
Vaughan
and Parry
(2016)
To
determine
sepsis
assessment
and
management
, with
special focus
on need of
identifying
sepsis signs
and
symptoms at
an early
stage
Secondary
research
Thorough and
comprehensiv
e search of
different
electronic
databases to
retrieve
scholarly
articles and
clinical
guidelines
The ABCDE
approach for
patient
assessment has
been found most
effective for
determining the
presence of
sepsis, and helps
the nursing
professionals to
identify sepsis
correctly, in
contrast to the
basic technique
performing vital
physical
observations.
In recent
years,
identification
and
management
of sepsis has
gained
considerable
attention and
requires
early
treatment in
order to
facilitate
appropriate
recognition
of signs and
symptoms

Vaughan
and Parry
(2016)
To explore
the efficacy
of different
sepsis care
bundles and
each of the
interventions
that are
illustrated in
the bundles
Secondary
research
Thorough and
comprehensiv
e search of
different
electronic
databases to
retrieve
scholarly
articles and
clinical
guidelines
Management of
sepsis must be
done showing
adherence to the
sepsis six care
bundle that
comprises of
administering
high flow
oxygen to the
patients,
followed by
commencement
of intravenous
fluid
resuscitation,
obtaining blood
cultures from the
patents,
administering
broad-spectrum
antibiotics,
evaluating blood
including
haemoglobin
Following
identification
of sepsis in a
patient, it is
imperative
for a nurse to
provide early
intervention,
based on the
guidelines,
to enhance
patient
outcomes

and lactate
levels, and
insertion of
urinary catheter
for monitoring
the urine output
Williams
et al.
(2014)
To
formulate a
clinical
pathway for
management
of patients
who are
suspected to
suffer from
neutropenic
sepsis
Retrospecti
ve cohort
study
Audit
conducted
amid 100%
patients who
had been
provided
chemotherapy
within a time
period of 6
weeks, and
reported
presence of
infection, or
pyrexia, or
antibiotic
administration
, 1 hour after
arrival
Antibiotics were
provided to 31%
patients, within
an hour of their
admission to the
facility. Re-audit
showed that 97%
patients received
antibiotics and
there was 0%
mortality referral
The care
pathway,
based on
NICE
guidelines
resulted in
an
improvement
in patient
safety and
experience
Table 1- Summary table for the studies included in the review

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