| Summary: | Objective: To assess the impact of each measure in the six and 24-hour bundles of a Managed Care Program in the care of a cohort of hospitalized severe sepsis / septic shock patients. Methods: A prospective study was carried out with 316 consecutive patients with severe sepsis / septic shock, assessing the impact on mortality by calculating the Odds Ratio of each single action (significance level of 5%). Rresults: In the sample there were 57% males, the mean age was 65.24 years, the APACHE II score was over 25 in 39.2%; 71.8% had a diagnosis of septic shock, and 65.5% required mechanical ventilation. Furthermore, 88.9% of patients had at least two organ dysfunctions upon the initial presentation. Only the blood culture collected before starting antibiotics: OR = 0.54 (95% CI: 0.33-0.87; p < 0.009) and the introduction of antibiotics by no later than 120 minutes after the diagnosis: OR = 0.44 (95% CI: 0.23-0.87; p < 0.009) were significant. Other six-hour bundle items tended towards a worse outcome. Results were superior in the 24-hour bundles with interventions in all four items, although without statistical significance. Cconclusions: The single impact of all interventions in the bundles occurred due to only two items: collecting blood cultures before starting antibiotics and early use (by 120 minutes) of antibiotics. Future evaluations in larger databases including multivariate analysis may support these findings.
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