The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis
Open accessAbstract
OBJECTIVE: The Surviving Sepsis Campaign (SSC or "the Campaign") developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes. DESIGN AND SETTING: A multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were "bundled" into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008. MAIN RESULTS: Data from 15,022 subjects at 165 sites were analyzed to determine the compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 years (P<0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years (P = 0.008). Compliance with all bundle elements increased significantly, except for inspiratory plateau pressure, which was high at baseline. Unadjusted hospital mortality decreased from 37 to 30.8% over 2 years (P = 0.001). The adjusted odds ratio for mortality improved the longer a site was in the Campaign, resulting in an adjusted absolute drop of 0.8% per quarter and 5.4% over 2 years (95% CI, 2.5-8.4%). CONCLUSIONS: The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts.
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The 2016 SSC guideline recommended a minimum of 30 ml/kg ideal body weight IV crystalloids in initial fluid resuscitation, based on observational evidence.
“The 2016 SSC guideline issued a recommendation for using a minimum of 30 ml/kg (ideal body weight) of IV crystalloids in initial fluid resuscitation. This fixed volume of initial resuscitation was based on observational evidence [62].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [62]
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- Authors
- Levy, M. M., Dellinger, R. P., Townsend, S. R., Linde-Zwirble, W. T., Marshall, J. C., Bion, J., Schorr, C., Artigas, A., Ramsay, G., Beale, R., Parker, M. M., Gerlach, H., Reinhart, K., Silva, E., Harvey, M., Regan, S., & Angus, D. C.
- Affiliations
- Brown University (US)
- Cooper University Hospital (US)
- University of Massachusetts Chan Medical School (US)
- St. Michael's Hospital (CA)
- Queen Elizabeth Hospital Birmingham (GB)
- Universitat Autònoma de Barcelona (ES)
- Mid Essex Hospital Services NHS Trust (GB)
- Guy's Hospital (GB)
- Stony Brook University (US)
- Vivantes Klinikum (DE)
- Harvard University (US)
- University of Pittsburgh (US)
- Corresponding author
- Levy, Mitchell M.
- ORCID
- Venue
- Intensive Care Medicine
- Published
- 2010-01-13
- Volume
- 36
- Issue
- 2
- Pages
- 222-231
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- PMC
- PMC2826633
- OpenAlex
- W2134689623
- Cited by
- 868
- References
- 38
- Citations by year
- 2026: 15 · 2025: 31 · 2024: 22 · 2023: 27 · 2022: 26 · 2021: 39 · 2020: 41 · 2019: 41 · 2018: 45 · 2017: 74 · 2016: 73 · 2015: 82 · 2014: 84 · 2013: 93 · 2012: 86
- FWCI
- 61.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Intensive Care Medicine (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Edwards Lifesciences
- Eisai
- European Society of Intensive Care Medicine
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Keywords
- Surviving Sepsis Campaign, severe sepsis, septic shock, guideline adherence, quality improvement, in-hospital mortality, sepsis resuscitation
- MeSH terms
- Health Promotion, Humans, Medical Audit, Shock, Septic, Confidence Intervals, Odds Ratio, Treatment Outcome, Hospital Mortality, Practice Guidelines as Topic, Reticulocyte Count, Sepsis, Guideline Adherence
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