Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study
Abstract Background The burden of sepsis is highest in low- and middle-income countries, though the management of sepsis in these settings is poorly characterized. Therefore, the objective of this study was to assess the early management of sepsis in Thailand. Methods Pre-planned analysis of the Ubo...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-019-0407-z |
| _version_ | 1819072581258444800 |
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| author | Kristina E. Rudd Viriya Hantrakun Ranjani Somayaji Suchart Booraphun Chaiyaporn Boonsri Annette L. Fitzpatrick Nicholas P. J. Day Prapit Teparrukkul Direk Limmathurotsakul T. Eoin West |
| author_facet | Kristina E. Rudd Viriya Hantrakun Ranjani Somayaji Suchart Booraphun Chaiyaporn Boonsri Annette L. Fitzpatrick Nicholas P. J. Day Prapit Teparrukkul Direk Limmathurotsakul T. Eoin West |
| author_sort | Kristina E. Rudd |
| collection | DOAJ |
| description | Abstract Background The burden of sepsis is highest in low- and middle-income countries, though the management of sepsis in these settings is poorly characterized. Therefore, the objective of this study was to assess the early management of sepsis in Thailand. Methods Pre-planned analysis of the Ubon-sepsis study, a single-center prospective cohort study of Thai adults admitted to the general medical wards and medical intensive care units (ICUs) of a regional referral hospital with community-acquired sepsis. Results Between March 2013 and January 2017, 3,716 patients with sepsis were enrolled. The median age was 59 years (IQR 44-72, range 18-101), 58% were male, and 88% were transferred from other hospitals. Eighty-six percent of patients (N = 3,206) were evaluated in the Emergency Department (ED), where median length of stay was less than 1 hour. Within the first day of admission, most patients (83%, N = 3,089) were admitted to the general medical wards, while 17% were admitted to the ICUs. Patients admitted to the ICUs had similar age, gender, and comorbidities, but had more organ dysfunction and were more likely to receive measured sepsis management interventions. Overall, 84% (N = 3,136) had blood cultures ordered and 89% (N = 3,308) received antibiotics within the first day of hospital admission. Among the 3,089 patients admitted to the general medical wards, 38% (N = 1,165) received an adrenergic agent, and 21% (N = 650) received invasive mechanical ventilation. Overall mortality at 28 days was 21% (765/3,716), and 28-day mortality in patients admitted to the ICUs was higher than that in patients admitted to the general medical wards within the first day (42% [263/627] vs. 16% [502/3,089], p < 0.001). Conclusions Sepsis in a regional referral hospital in rural Thailand, where some critical care resources are limited, is commonly managed on general medical wards despite high rates of respiratory failure and shock. Enhancing sepsis care in the ED and general wards, as well as improving access to ICUs, may be beneficial in reducing mortality. Trial registration The Ubon-sepsis study was registered on clinicaltrials.gov (NCT02217592). |
| first_indexed | 2024-12-21T17:40:00Z |
| format | Article |
| id | doaj.art-4577547bc9e9406d84f9a140062f98ee |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-12-21T17:40:00Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-4577547bc9e9406d84f9a140062f98ee2022-12-21T18:55:38ZengBMCJournal of Intensive Care2052-04922019-12-01711810.1186/s40560-019-0407-zEarly management of sepsis in medical patients in rural Thailand: a single-center prospective observational studyKristina E. Rudd0Viriya Hantrakun1Ranjani Somayaji2Suchart Booraphun3Chaiyaporn Boonsri4Annette L. Fitzpatrick5Nicholas P. J. Day6Prapit Teparrukkul7Direk Limmathurotsakul8T. Eoin West9International Respiratory and Severe Illness Center, University of WashingtonMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of WashingtonSunpasitthiprasong HospitalSunpasitthiprasong HospitalDepartments of Family Medicine, Epidemiology, and Global Health, University of WashingtonMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversitySunpasitthiprasong HospitalMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityInternational Respiratory and Severe Illness Center, University of WashingtonAbstract Background The burden of sepsis is highest in low- and middle-income countries, though the management of sepsis in these settings is poorly characterized. Therefore, the objective of this study was to assess the early management of sepsis in Thailand. Methods Pre-planned analysis of the Ubon-sepsis study, a single-center prospective cohort study of Thai adults admitted to the general medical wards and medical intensive care units (ICUs) of a regional referral hospital with community-acquired sepsis. Results Between March 2013 and January 2017, 3,716 patients with sepsis were enrolled. The median age was 59 years (IQR 44-72, range 18-101), 58% were male, and 88% were transferred from other hospitals. Eighty-six percent of patients (N = 3,206) were evaluated in the Emergency Department (ED), where median length of stay was less than 1 hour. Within the first day of admission, most patients (83%, N = 3,089) were admitted to the general medical wards, while 17% were admitted to the ICUs. Patients admitted to the ICUs had similar age, gender, and comorbidities, but had more organ dysfunction and were more likely to receive measured sepsis management interventions. Overall, 84% (N = 3,136) had blood cultures ordered and 89% (N = 3,308) received antibiotics within the first day of hospital admission. Among the 3,089 patients admitted to the general medical wards, 38% (N = 1,165) received an adrenergic agent, and 21% (N = 650) received invasive mechanical ventilation. Overall mortality at 28 days was 21% (765/3,716), and 28-day mortality in patients admitted to the ICUs was higher than that in patients admitted to the general medical wards within the first day (42% [263/627] vs. 16% [502/3,089], p < 0.001). Conclusions Sepsis in a regional referral hospital in rural Thailand, where some critical care resources are limited, is commonly managed on general medical wards despite high rates of respiratory failure and shock. Enhancing sepsis care in the ED and general wards, as well as improving access to ICUs, may be beneficial in reducing mortality. Trial registration The Ubon-sepsis study was registered on clinicaltrials.gov (NCT02217592).https://doi.org/10.1186/s40560-019-0407-zSepsisCritical careGlobal healthManagementThailand |
| spellingShingle | Kristina E. Rudd Viriya Hantrakun Ranjani Somayaji Suchart Booraphun Chaiyaporn Boonsri Annette L. Fitzpatrick Nicholas P. J. Day Prapit Teparrukkul Direk Limmathurotsakul T. Eoin West Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study Journal of Intensive Care Sepsis Critical care Global health Management Thailand |
| title | Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study |
| title_full | Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study |
| title_fullStr | Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study |
| title_full_unstemmed | Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study |
| title_short | Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study |
| title_sort | early management of sepsis in medical patients in rural thailand a single center prospective observational study |
| topic | Sepsis Critical care Global health Management Thailand |
| url | https://doi.org/10.1186/s40560-019-0407-z |
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