The Effect of Early Goal-Directed Nursing Intervention on Severity of Organ Failure in Patients with Sepsis Syndrome
Main Article Content
Abstract
Purpose: To assess efficacy of the goal-directed nursing intervention within the first six hours compared with the routine nursing care in the patients with sepsis syndrome.
Design: The quasi-experimental research.
Methods: The sample consisted of medical patients with sepsis syndrome and had been admitted to the medical unit and intensive care unit at Lerdsin hospital, Bangkok, Thailand. Seventy patients were recruited and assigned to a control or intervention group by using a simple random sampling technique. The Intervention group received early goal-directed nursing intervention, while the control group received routine nursing care. The research instrument guideline were collected through 1) The early goal-directed nursing intervention within the first six hours in the patients with sepsis syndrome. 2) The Sequential Organ Failure Assessment “SOFA”. The Mann-Whitney U Test method was used to analyze the data.
Main findings: The results revealed within 48 hours that levels of severity of organ failure in the early goal-directed nursing intervention group were significantly lower than in the control group (p < .05). Patients’ complication in the intervention group was 11% lower, mortality rate was 2.86% lower when compared with the control group.
Conclusion and recommendations: The findings of this study suggest that patients with sepsis syndrome may benefit from early goal-directed nursing intervention. It can help reduce the severity of organ failure, complication and mortality rate. The researcher suggests that nurses as well as other health care personnel should use the early goal-directed nursing intervention to patients with sepsis syndrome.
Article Details
Copyright Notice: Nursing Science Journal of Thailand has exclusive rights to publish and distribute the manuscript and all contents therein. Without the journal’s permission, the dissemination of the manuscript in another journal or online, and the reproduction of the manuscript for non-educational purpose are prohibited.
Disclaimer: The opinion expressed and figures provided in this journal, NSJT, are the sole responsibility of the authors. The editorial board bears no responsibility in this regard.
References
Linde-Zwirble WT, Angus DC. Severe sepsis epidemiology: sampling, selection, and society. Critical Care 2004; 8(4): 222-26.
Esteban A, Frutos-Vivar F, Ferguson ND, Penuelas O, Lorente JA, Gordo F, et al. Sepsis incidence and outcome: Contrasting the intensive care unit with the hospital ward. Crit Care Med 2007; 35(5): 1284-90.
Kern JW, Shoemaker WC. Meta- analysis of hemodynamic optimization in high -risk patient. Crit Care Med 2003; 24: 1686-92.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early Goal - Directed Therapy in the treatment of severe sepsis and septic shock. NEJM 2001; 345(19): 1368-78.
Rivers EP, McIntyre L, Morro DC, Rivers KK. Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity. CMAJ 2005; 173(9): 1054-66.
Picard KM, O’Donoghue SC, Young-Kershaw DA, Russell KJ. Delvelopment and Implementation of a Multidisciplinary Sepsis Protocol. CCN 2006; 26(3): 43-56.
Vincent J-L, Abraham E, Annane D, Bernard G, Rivers E, Berghe GVd. The SOFA (Sepsis- related Organ Failure Assessment) score to describe organ dysfunction / failure. Intensive Care Med 1996; 22: 707-10.
สุณีรัตน์ คงเสรีพงศ์. เวชบำบัดวิกฤต. กรุงเทพ: โรงพิมพ์เรือนแก้วการพิมพ์; 2543.
Routsi C, M. Pratikaki, C. Sotiropoulou, E. Platsouka, V. Markaki, O. Paniara, et . Application of the Sequential Organ Failure assessment (SOFA) score to bacteremic ICU patients. Infection 2007; 35: 240-4.
Ely EW, Kleinpell RM, Goyette RE. Advances in the understanding of clinical manifestaions and therapy of sever sepsis: an update for critical care nurses. Am J Crit care 2003; 12: 120-35.
Giuliano KK.Continuous Physiologic Monitoring and the Identification of Sepsis. AACN 2006; 17(2): 215-23.
Rivera C. Maintain the urgency of sepsis recognition and treatment. BACN; 3(2): 43-50.
Ruffell AJ. Sepsis strategies: an ICU package? BACN 2004; 19(6): 257-64.
Ferreira FL, Bota DP, Bross A, Me/lot C, MSciBiostat. Serial Evaluation of the SOFA Score to Predict Outcome Critically Ill Patients. JAMA 2001; 286(14): 1754- 8.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31(4): 1250-6.
Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med 2010; 38(2): 367-74.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36(1): 296- 328.
Brun-Buisson C, Doyon F, Carcillo J, Dellamonica P, Gouin F, Lepoutre A, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units. JAMA 1995; 274: 968-74.
Martin GS, Mannino DM, Eaton S, Moss M. The Epidemiology of Sepsis in the United States from 1979 through 2000. NEJM 2003; 348(16): 1546-54.
Shapiro NI, Howell MD, Talmor D, Ngo DL, Buras J, Wolfe RE, et al. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med 2006;34(4): 1025-33.