Khảo sát sự tuân thủ gói 1 giờ trong chăm sóc điều trị sốc nhiễm khuẩn

Abstract

Objective: To survey on compliance with the application of 1-hour bundle in the treatment of septic shock at 108 Military Central Hospital. Subject and method: A prospective observational study was conducted on 52 septic shock patients at the Internal Intensive Care Unit - 108 Military Central Hospital from June 2021 to March 2022. The application of the 1-hour bundle was evaluated on the criterias: Fluid resuscitation, blood culture, early antibiotics, blood lactate measurement, and vasopressor. Treatment results when applying the 1-hour bundle were evaluated based on clinical outcomes, survival after 7 days, time of mechanical ventilation, number of dialysis sessions, number of days in the ICU. Result: In 52 patients participating in the study, the proportion of men was 73.1% and women was 26.9%. The mean age was 74.9 ± 14.6 years old. The 1-hour bundle compliance survey showed that 100% of patients received vasopressors and fluid resuscitation therapy. Meanwhile, the patients receiving blood culture, arterial blood gas accounted for 57.7% and 82.7% respectively, and the rate of antibiotic use in the first hour was only 44.2%. In the group of patients receiving antibiotics early, proportion of patients, who were being treated in the ICU, was significantly higher than patients who was transferred from other clinical departments (69.6% vs 30.4%, p<0.05). In terms of clinical outcomes, the group that compliance using antibiotic early had a significantly lower mean ICU stay than the uncompliant group (6.9 days and 16.1 days, p<0.05). The number of dialysis sessions in the compliance group was also significantly lower with 0.8 times, in comparation with the uncompliant group, 2.5 times (p<0.05). There was no significant difference in 7-day mortality between the 2 groups (p>0.05). Conclusion: The study showed that the 1-hour bundle compliance that according to the guidelines of the Surviving Sepsis Campaign 2018 in the treatment of septic shock has performed well in the use of vasopressors and fluid resuscitation, but has not be good in the use of early antibiotics and blood cultures. There should be training programs for medical staff in early diagnosis of septic shock, applying the 1-hour bundle thoroughly, especially antibiotics and early blood culture.