Severe sepsis treatment protocol HUPE against sepsis

Abstract

Brazilian National Health Institute initiated the project “Brazil against sepsis” in April 2012. In August of the same year a multiprofessional team was organized to take care of this project in Pedro Ernesto University Hospital. In September this team initiated medicine and nursing professionals, residents and graduation students training in order to obtain the best treatment protocol adhesion. The main objective of this protocol is the reduction of severe sepsis mortality. The treatment protocol is based on the Surviving Sepsis Campaign six hour package. It includes: quick severe sepsis recognition; laboratory exams collection, including arterial lactate and blood cultures, and also hemogram, glucose, urea, creatinine, total bilirubin, prothrombintime (INR) and partially activated thromboplastin time; antibiotic therapy initiated within the first hour of diagnosis; for patients with hypotension, with signs of inadequate tissue perfusion, including arterial lactate > 4 mmol/l, blood volume expansion with 0,9% saline, 20 to 30 ml/kg in the first hour, and evaluation of vasopressor amines indication. The hemodynamic targets are: central venous pressure – 8 to12 mmHg; mean arterial pressure > 65 mmHg; central venous oxygen saturation > 70%; lactate clearance > 10% in 6 hours; diuresis > 0,5 mL/kg/h. In order to achieve these goals some arrangements were provided: form of diagnosis and initial management of patients with severe sepsis; request form to obtain tray with material for deep venous puncture, central venous pressure measurement and blood cultures bottles; flowchart for quickly obtaining the first dose of antibiotic, flowchart for rapid achievement of the first laboratory tests; expediting the release of the results of cultures.