Answering the Clinical Question of Mortality Benefit from Using the Sepsis Resuscitation Bundle Alone

Tuesday, 23 July 2013: 10:45 AM

Jamie K. Roney, BSN, RN, CCRN
School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX
Michelle A. Pinelle, BSN, RN, CCRN
Critical Care Unit, Vail Valley Medical Center, Vail, CO

Learning Objective 1: The learner will be able to discuss the impact of using the Sepsis Resuscitation Bundle on patient mortality according to available research

Learning Objective 2: The learner will be able to identify current research findings supporting clinical decisions to use the Sepsis Resuscitation Bundle alone

Purpose: The Sepsis Resuscitation Bundle (SRB) should be implemented for the management of severe sepsis, septic shock, or lactic acid > 4 mmol/l with confirmed or suspected infection according to the evaluation of available evidence. The clinical question looked to answer whether only partial early goal-directed therapy (EGDT), the SRB, could be used and still demonstrate a positive impact on mortality.

 Methods: Systematic review of eight articles and the practice guideline were analyzed for applicability, strength of the evidence, validity of the results, and gaps in the studies’ findings. The articles revealed evidence that using SRB reduced mortality. Rivers et al.1 conducted research without gaps in their study and the clinical question asked. This correlation was strengthened by the study design’s meta-analysis of over 50 publications and large sample size of over 18,000 adults. Although the studies included in the meta-analysis were not randomized controlled trials, clinical criteria were met making it the most influential findings for application to practice.

Results: There was variability in the interventions applied in the reviewed studies. Five of the studies and practice guideline used EGDT as the intervention. The two out of the eleven studies that researched the unmodified SRB, both meta-analyses representing levels of evidence III and IV, demonstrated a clinically significant reduction in mortality. Rivers et al.1 meta-analysis of cohort studies provided the strongest evidence to support use of the SRB by demonstrating a RRR of 0.37, ARR of 18.3%, NNT of 5.45, and a crude mortality reduction of 17.7%.

Conclusion: Evidence identified through a systematic review of current research supported the use of the SRB independently to reduce mortality in adult patients with severe sepsis, septic shock, or lactic acid > 4 mmol/l with confirmed or suspected infection admitted to acute care facilities.