G as shown by our data above and are in support
G as shown by our data above and are in support of previous findings [2-4]. The results are limited by the lack of controls; however, we believe that further randomized controlled clinical studies using this therapy are warranted, more so in view of the fact that no specific treatment against septic shock is available. References 1. Marshall JC, et al: Diagnostic and prognostic implications of endotoxemia in critical illness: results of the MEDIC study. J Infect Dis 2004, 190:527-534. 2. Kulabukhov V: Use of novel technique for adsorption of lipopolysaccharide in the combined treatment of patients with severe organ negative sepsis [abstract 78]. Sepsis 2008; An International Sepsis Symposium; Paris. France. 3. Kulabukhov V, Chizhov A, Kleuzovich A, Kudryavtsev A: Clinical effects of adsorption of lipopolysaccharide in the treatment of Gram-negative severe sepsis. Crit Care 2010, 14(Suppl 2):P28. 4. Ala-Kokko TI, Laurila J, Koskenkari J: A new endotoxin adsorber in septic shock: observational case series. Blood Purif 2011, 32:303-309.P76 Audit of the ward-based management of severe sepsis in a large teaching hospital G Estebanez*, M Cole Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK Critical Care 2012, 16(Suppl 3):PBackground: The Surviving Sepsis 6-hour bundle [1] was created to promote effective identification and management of patients with severe sepsis and septic shock. Efficient and timely implementation of the 6-hour bundle including early intravenous antibiotics has been shown to improve patient outcome [2]. We aimed to determine the efficiency of severe sepsis identification, implementation of the 6-hour bundle and overall management of ward-based PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28388412 patients. Methods: During a 4-month period, ward-based patients with severe sepsis were identified by nurse practitioners and the critical care outreach team at a large teaching hospital in North West England. Analysis of patient medical ZM241385 cost records was performed to assess the efficiency and quality of care received compared with the gold standard sepsis 6-hour bundle. Promptness of doctor attendance and patient 30-day outcome were also analysed. Results: Twenty-eight patients with severe sepsis were identified and analysed. Suspicion of sepsis was documented in medical records for all patients; however, the 6-hour sepsis bundle was completed in only one case. Appropriate i.v. antibiotics were prescribed to all patients. Median duration from the documented onset of severe sepsis (time 0) until review by a doctor was 90 minutes (0 to 19 hours). The median Modified Early Warning Score (MEWS), determined from patients’ vital signs, at documented onset of severe sepsis was 3.5 (1 to 9) with a subsequent increase of median MEWS to 4 by the time of doctors’ first attendance. The 30-day patient outcome showed 13 patients discharged home and seven patients deceased. Comparison of deceased patients with patients who were discharged alive (see Table 1) demonstrated an increased median duration from time 0 until doctor attendance in the deceased group. However, interestingly, timely antibiotics (given within 1 hour of patient assessment by a doctor) were administered with greater frequency in the deceased patient group. Conclusion: Despite the widespread recognition of patients with severe sepsis, underperformance of the 6-hour bundle remains a major factor inCritical Care 2012, Volume 16 Suppl 3 http://ccforum.com/supplements/16/SPage 39 ofTable 1(abstract P76) Charact.