Pedja Kovacevic, MD, PhD, FCCP
Prof
University Clinical Centre of the Republic of Srspka
Banja Luka, Bolivia
Disclosure information not submitted.
Milka Jandric, MD
Critical Care Physicians
University Clinical Centre of Republika Srspka, United States
Disclosure information not submitted.
Tijana Kovacevic, Ph.D.
Pharmacist
University Clinical Centre of Republika Srspka, United States
Disclosure information not submitted.
Biljana Zlojutro, MD
Critical Care Physicians
University Clinical Centre of Republika Srspka, United States
Disclosure information not submitted.
Danica Momcicevic, MD
Critical Care Physicians
University Clinical Centre of Republika Srspka, United States
Disclosure information not submitted.
Sasa Dragic, MD. Ph.D.
Critical Care Physicians
University Clinical Centre of Republika Srspka, United States
Disclosure information not submitted.
Title: Impact of specific Checklists on Treatment of Critically Ill Septic Patients in a Low-Resource MICU
Introduction:
Treatment of sepsis and septic shock can be a challenge even for intensive care units (ICUs) in high income countries, but it is especially difficult for ICUs with limited resources.
Aim:
To evaluate the impact of CERTAIN on treatment of critically ill septic patients in low-resource medical ICU.
Methods:
In a before-and-after study design, we compared clinical outcomes, processes, and complications (hospital acquired infections) 1 year before and 2 years after (2016 and 2017) introduction of
CERTAIN.
Results:
A total of 125 patients with sepsis were prospectively identified for a 3-year period. Mean patient age, gender distribution, number of patients on mechanical ventilation (33 [76.7%] vs. 42 [84%] vs. 24 [75%]) and vasopressor use (23 [53.5%] vs. 34 [68%] vs. 24 [75%]) were similar before (2015) and 2 years after (2016 and 2017) the implementation of CERTAIN. Severity of illness (Simplified Acute Physiology Score II [SAPS II score]) was higher after the implementation. The checklist was incorporated in the daily practice with 100% adherence to its use. The duration of mechanical ventilation (5.3 – 5.3 vs. 4.2 – 3.6 vs. 3.7 – 5.5), antibiotic treatment (8.2 – 5.4 vs. 6.9 – 4.1 vs. 5.8 – 5.6), central venous catheter use (6.2 – 5.7 vs. 5.7 – 4.6 vs. 4.2 – 6.1), ICU stay (8.4 – 5.4 vs. 7.1 – 4.1 vs. 5.8 – 5.6), and the incidence of nosocomial infection (33.3% vs. 30% vs. 12.5%) decreased in the period after the onset of the intervention, but the results did not reach statistical significance. When adjusted for baseline characteristics, CERTAIN was not associated with hospital mortality (odds ratio 0.88, 0.38–2.04).
Conclusion:
CERTAIN was readily adopted in the ICU workflow and was associated with improvement in treatment of critically ill patients with sepsis.