Lefrant et al. (2010) [37] | To determine whether the implementation of 10 recommendations adapted from the SSC guidelines results in a reduction of mortality inpatients with severe sepsis and septic shock. | Quasi-experimental study that had two consecutive phases: a 6-month quality control period (observational) and secondly a 6-month intervention period. | 15 ICUs in southern France. | N = 538 Consecutive | 2006 | The 28-day mortality rate significantly decreased from 40% in the observational period to27% in the intervention period (p = 0.02). |
Leisman et al. (2017) [38] | To determine mortality and costs associated with adherence to an aggressive, 3-hour sepsis bundle versus noncompliance with greater than or equal to one bundle element for severe sepsis and septic shock patients. | Prospective, multisite, observational study used three sequential, independent cohorts, from a single USA health system, through their hospitalization. | Three cohorts in the USA: cohort 1: five tertiary and six community hospitals. Cohort 2: single tertiary academic medical center. Cohort 3: five tertiary and four community hospitals. | N = 14,755 (n1 = 5819, n2 = 1697, n3 = 7239) Consecutive | 2010 | In the three independent cohorts, 3-hour bundle compliance was associated with improved survival and cost savings. Mortality rate for compliant and non-compliant groups were: 21.3% and 25.4%, 13.4% and 17.8% and 18.1% and 21%, for cohorts 1, 2 and 3, respectively. |
Memon et al. (2012) [39] | To assess the effect of improved compliance with the 6-hour sepsis resuscitation bundle on mortality of patients with severe sepsis and septic shock. | Quasi-experimental prospective design with a historical group as a control, and an intervention that was introduced over a 3-month period. | 10-bedded combined medical and surgical ICU in a governmental hospital in Saudi Arabia. | N = 299 Consecutive | 2009-2011 | The overall compliance with 6-hour sepsis resuscitation bundle elements was associated with improved survival[OR, 5.8 (95% CI, 2.2 - 15.1; p < 0.001)]. 30-day hospital mortality reduced from 31.3% in the historical group to 21.1% in the intervention group; p = 0.05. There was a significant 30-day hospital mortality reduction in the post-intervention group. |