Factors Associated with Compliance with Sepsis Bundle Care in the Intensive Care Unit

在加護病房單位有關敗血症準則順從性的因素分析

張雅淳(Ya-Chun Chang) ； 陳泓丞(Hung-Chen Chen) ； 王金洲(Chin-Chou Wang) ； 曾嘉成(Chia-Cheng Tseng) ； 杜美蓮(Mei-Lien Tu) ； 林孟志(Meng-Chih Lin) ； 方文豐(Wen-Feng Fang)

《胸腔醫學》 27卷5期 (2012/10) Pp. 260-269

https://doi.org/10.29806/TM.201210.0001

摘要

背景：此研究的目的為找出哪些因素與敗血症準則的順從性相關。病人及方法：收錄自2009年12月至2010年12月，45個因敗血症重症住進高雄長庚醫院內科加護病房的病人。分析與敗血症準則順從性相關的因素，如病人的來源、是否使用敗血症碼、自插管至加護病房的時間、年齡、APACHE II分數、器官衰竭的數目、進入加護病房的時間、護理師與照護床數比、病人被診斷出敗血症重症的地點、有無時間置入中央靜脈導管。結果：6小時復甦套裝全部完成有17.8%，而24小時處置套裝全部完成有11.1%。雖然使用敗血症碼，或是自插管至加護病房的時間來比較是否遵循敗血症套裝（不論6小時復甦套裝或是24小時處置套裝）均未達統計學上的意義。但病人的來源，進入加護病房的時間，進入加護病房時的住院醫師，護理師與照護床數比，及器官衰竭的數目與敗血症套裝細項的遵循及完成有關。結論：有很多的因素與敗血症套裝細項的執行有關，如病人的來源，進入加護病房的時間，進入加護病房時的住院醫師，護理師與照護床數比，及器官衰竭的數目。我們期望透過這個研究能讓我們更注意這些因素，來達到改善敗血症套裝細項的執行。

關鍵字

戰勝敗血症準則 ； 敗血症套裝 ； 6小時復甦套裝 ； 24小時處置套裝

並列摘要

Background: The aim of this study was to determine which factors are associated with compliance with sepsis bundle care in the intensive care unit.Patients and Methods: Forty-five patients with severe sepsis admitted to the medical intensive care units of Kaohsiung Chang Gung Memorial Hospital from December 2009 through December 2010 were enrolled. We analyzed the factors, including patient, organizational, and process factors, that were most likely associated with compliance with the sepsis bundle.Results: The total compliance rate with the 6-hour resuscitation bundle was 17.8%, and that with the 24-hour management bundle was 11.1%. When comparing patient groups with compliance or non-compliance with the sepsis bundle (either 6-hour or 24-hour), there was no statistically significant difference among factors, such as using the sepsis code and intubation-to-ICU time. However, admission source, admission time, resident at admission, nurse-to-bed ratio, and number of dysfunctional organs were associated with compliance with detailed bundle elements.Conclusions: The factors that are associated with compliance with sepsis bundle elements in the intensive care unit include admission source, admission time, resident at admission, nurse-to-bed ratio, and number of dysfunctional organs. We should be aware of these factors, to improve compliance with sepsis bundle elements.

並列關鍵字

surviving sepsis campaign guideline ； sepsis bundle ； 6-hr resuscitation bundle ； 24-hr management bundle