Process and Outcomes of Early Goal-Directed Therapy in Patients with Severe Sepsis and Septic Shock

Abstract

The aim of this retrospective descriptive study was to investigate the process and outcomes of the Early-Goal Directed Therapy (EGDT) in patients with severe sepsis and septic shock in Singburi hospital by using Donabedian model as a conceptual framework.

The purposive sample of 120 medical records, 75 patients diagnosed with severe sepsis and 45 patients with septic shock, in intensive care unit and medical unit was recruited for this study. The instruments used were 1) the personal information sheet and 2) the EGDT process and outcomes record forms. Descriptive statistics was used for data analysis.

The results were as follows: the time for assessment and diagnosis was 16 – 42 minutes (M 26.37, SD 5.95). Hemoculture time was 5 - 21 minutes (M 11.75, SD 2.65). Antibiotics time was 11 - 26 minutes

(M 17.98, SD 3.41). The samples younger than 60 years received IV fluid resuscitation 680 - 2,100 ml (M 1,215.60, SD 343.82), and over 60 years received 450 - 1,300 ml (M 929.13, SD 169.61). Norepinephrine was started in 4 - 42 minutes (M 21.22, SD 8.42).

Seventy-six patients with severe sepsis achieved the goal of the process in 6 hours (88%) and 55 survived (83.3%). For patients with septic shock, 40 achieved the goal (88.89%) and 24 survived (60%). According to the findings, caring outcome of intensive care unit met the criteria more than that of the internal ward; therefore, continuous training program to improve knowledge and skills for nurse working in internal wards was recommended.