A Focus on Sepsis Implementation of the Surviving Sepsis Campaign guidelines for severe sepsis and septic shock: We could go faster Massimo Zambon MD a , Marcello Ceola MD b , Roberto Almeida-de-Castro MD a , Antonino Gullo MD a , Jean-Louis Vincent MD, PhD b, ⁎ a Department of Anesthesiology and Intensive Care, Cattinara Hospital, University of Trieste, Italy 447-34149 b Department of Intensive Care, Erasme Hospital, Free University of Brussels, 1070 Brussels, Belgium Keywords: Sepsis bundle; Intensive care unit; Septic shock Abstract Purpose: The aim of this study is to evaluate the feasibility of applying sepsis bundles in the intensive care unit (ICU) and their effect on outcomes. Methods: In this prospective, observational study in a 31-bed capacity department of intensive care, we measured the time taken to perform sepsis bundle interventions in 69 consecutive patients with severe sepsis or septic shock. Results: Compliance with the 6-hour bundle was obtained in 44 (72%) of 61 patients; these patients had a lower mortality rate (16% vs 41%, P = .04) and shorter ICU stay (median [range], 5 [3-10] vs 9 [6-19] days, P = .01) than other patients. Compliance with the 24-hour bundle was obtained in 30 (67%) of 44 eligible patients. The mortality rate and duration of ICU stay were not significantly lower in the 24-hour compliant as compared with the noncompliant group (23% vs 33% and 6 [4-11] vs 9 [6-25] days, respectively; P value is not significant). Patients who complied with the 24-hour sepsis bundle after only 12 hours had a lower mortality rate (10% vs 39%, P = .036) and shorter stay (6 [4-10] vs 9 [6-25] days, P = .055) than those who were compliant after 24 hours. Conclusions: Correct application of the sepsis bundles was associated with reduced mortality and length of ICU stay. Earlier implementation of the 24-hour management bundle could result in better outcomes. © 2008 Elsevier Inc. All rights reserved. 1. Introduction Severe sepsis and septic shock are major problems in critically ill patients. In the recent European Sepsis Occur- rence in Acutely ill Patients study [1], which collected data on septic adult patients in 198 intensive care units (ICUs) from 24 European countries, ICU mortality was 32% for patients with severe sepsis and 54% when septic shock was present. Recent guidelines provided by the Surviving Sepsis Campaign (SSC) [2] provide an important tool for the management of patients with severe sepsis and septic shock. The next phase of the SSC involves the practical application ⁎ Corresponding author. Tel.: +32 2 555 3380; fax: +32 2 555 4555. E-mail address: jlvincen@ulb.ac.be (J.-L. Vincent). 0883-9441/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jcrc.2007.08.003 Journal of Critical Care (2008) 23, 455–460