Serious sepsis treatment in intensive care departments in the Czech Republic –  EPOSS Project pilot results


Authors: J. Maláska 1;  M. Slezák 1;  D. Schwarz 17;  J. Jarkovský 17;  M. Adamus 2;  K. Cvachovec 3;  V. Černý 4;  P. Dostál 4;  M. Fořtová 5;  E. Havel 6;  I. Herold 7;  E. Kasal 8;  R. Kula 9;  J. Maňák 10;  M. Matějovič 11;  D. Nalos 12;  R. Pařízková 4;  A. Šobáňová 13;  V. Šrámek 14;  J. Tichý 9;  R. Turek 15;  I. Zýková 16;  L. Dušek 17;  P. Ševčík 9;  Za Projekt Eposs:;  V. Agalarev 1;  P. Bakalík 1;  V. Belanová 13;  J. Cerman 6;  L. Číž 13;  L. Dadák 14;  J. Duba 1;  J. Fortunato 10;  T. Gabrhelík 2;  R. Gál 1;  R. Hůlek 17;  O. Hrdý 1;  M. Huchý 8;  I. Chytra 8;  D. Klimeš 17;  J. Klučka 1;  M. Kratochvíl 1;  L. Kosková 1;  J. Máca 9;  O. Mašlík 15;  M. Matysová 9;  P. Minarčíková 1;  J. Molnárová 15;  H. Ondrášková 1;  M. Pelichovská 3;  J. Polák 4;  R. Schwarz 9;  J. Stašek 1;  E. Straževská 1;  H. Suchomelová 1;  P. Suk 1;  P. Štourač 1;  J. Tichý 9;  M. Wolfová 15;  R. Uvízl 2;  H. Zapletalová 13;  J. Zatloukal 9;  I. Zimová 1
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Roman Gál, Ph. D. 1;  Klinika gerontologická a metabolická Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MU Dr. Luboš Sobotka, CSc. 10;  I. interní klinika Lékařské fakulty UK a FN Plzeň, přednosta prof. MU Dr. Martin Matějovič, Ph. D. 11;  Oddělení intenzivní medicíny Masarykovy nemocnice Ústí nad Labem, o. z., přednosta prim. MU Dr. Daniel Nalos 12;  Oddělení intenzivní péče operačních oborů Krajské nemocnice T. Bati, a. s., Zlín, přednostka prim. MU Dr. Anna Šobáňová 13;  Anesteziologicko‑resuscitační klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta doc. MU Dr. Vladimír Šrámek, Ph. D. 14;  Anesteziologicko‑resuscitační oddělení Krajské nemocnice T. Bati, a. s., Zlín, přednosta prim. MU Dr. Radovan Turek 15;  Anesteziologicko‑resuscitační oddělení Krajské nemocnice Liberec a. s., přednosta prim. MU Dr. Dušan Morman 16;  Institut bio­statistiky a analýz Lékařské a Přírodovědecké fakulty MU Brno, ředitel doc. RNDr. Ladislav Dušek, Ph. D. 17;  Klinika anesteziologie, resuscitace a intenzivní medicíny Lékařské fakulty UP a FN Olomouc, přednosta doc. MU Dr. Milan Adamus, Ph. D. 2;  Klinika anesteziologie, resuscitace a intenzivní péče 2. lékařské fakulty UK a FN Motol Praha, přednosta prof. MU Dr. Karel Cvachovec, CSc., MBA 3;  Klinika anesteziologie, resuscitace a intenzivní medicíny Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MU Dr. Vladimír Černý, Ph. D., FCCM 4;  Anesteziologicko‑resuscitační oddělení Pardubické krajské nemocnice, a. s., Pardubice, přednostka prim. MU Dr. Magdalena Fořtová 5;  Chirurgická klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MU Dr. Alexander Ferko, CSc. 6;  Anesteziologicko‑resuscitační oddělení Oblastní nemocnice Mladá Boleslav, a. s., Mladá Boleslav, přednosta prim. MU Dr. Ivan Herold, CSc. 7;  Anesteziologicko‑resuscitační klinika Lékařské fakulty UK a FN Plzeň, přednosta doc. MU Dr. Eduard Kasal, CSc. 8;  Anesteziologicko‑resuscitační klinika Lékařské fakulty OU a FN Ostrava, přednosta prof. MU Dr. Pavel Ševčík, CSc. 9
Published in: Vnitř Lék 2013; 59(11): 962-970
Category: Original Contributions

Overview

Introduction:
Severe sepsis is still associated with significant morbidity and mortality, which is however different, as well as its management, depending on the region. What is the situation in the Czech Republic and what is the character of patients with severe sepsis is currently not known. The aim of the project is to describe the processes of care, outcome and characteristics of patients with severe sepsis admitted to the intensive care department of the Czech Republic.

Methods:
This is a multicentre and observational project with retrospective enrollment of patients who meet the criteria for severe sepsis before or within 24 hours after admission to selected intensive care units (ICU‑ EPOSS).

Results:
394 patients were analyzed. Median age at admission was 66 (56– 76) years, males predominated (58.9%) and the median APACHE II score on admission was 25 (19– 32). Patients were predominantly medical (56.9%) and most were secondary admitted from other ICU (53.6%). Meeting the criteria of severe sepsis was most frequently within the period (± 4 hours) of admission the EPOSS‑ ICU (77.6%). Median total fluid intake during the first 24 hours was 6,680 (4,840– 9,450) ml. Most patients required mechanical ventilation (58.4%). Compliance with the resuscitation bundle of severe sepsis in our group was very good and was associated with lower mortality of patients. Most frequently, the EPOSS‑ ICU length of stay (LOS) was 7 (3– 15) days and median hospital LOS was 13 (8– 28) days. Hospital mortality in our cohort was 35.8%.

Conclusion:
Introducing the project, which in its first stage obtained valuable and internationally comparable data about patients with severe sepsis admitted to the involved ICU in the Czech Republic.

Key words:
severe sepsis –  intensive care –  treatment –  process of care –  outcome


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Diabetology Endocrinology Internal medicine

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