Fluid Resuscitation Compliance and Vasopressor Outcomes in Septic Shock: A Study of BPA-driven Management

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Abstract Evaluate the adherence to BPA alert instructions based on the Surviving Sepsis Campaign guidelines for treating septic shock. Septic shock is characterized by hypotension and organ dysfunction resulting from systemic infection. The Surviving Sepsis Campaign provides evidence-based guidelines for the early recognition and management of septic shock, yet adherence to these guidelines varies among healthcare systems. To address this variability, Best Practice Advisory (BPA) alerts have been integrated into electronic medical records. These alerts notify healthcare providers when patients meet specific diagnostic criteria, facilitating recognition and intervention. This analysis evaluates the compliance to the Society for Critical Care Medicine's Surviving Sepsis guidelines and subsequent patient outcomes after BPA alerts trigger. We conducted a retrospective analysis of 210 Systemic Inflammatory Response (SIRS) BPA alerts triggered between October 2023 and June 2024 at a tertiary academic hospital. Best Practice Alerts were filtered for patients meeting the Society for Critical Care Medicine's criteria for septic shock, defined by a lactate greater than 4 mmol/L or a systolic blood pressure less than 90 mmHg. Metrics analyzed included compliance with the recommended 30 mL/kg of fluid resuscitation, vasopressor requirements, and adherence to other elements of the Surviving Sepsis guidelines. Of 210 patients with SIRS BPA alerts, 26 met the criteria for septic shock. Among these patients, nine had contraindications to resuscitation due to comorbidities, including congestive heart failure, cirrhosis, or end-stage renal disease. Of the 17 remaining patients with no contraindications to aggressive resuscitation, three received appropriate resuscitation within three hours of the alert (18%), while eight were resuscitated within a 24-hour timeframe, beginning six hours prior to the BPA alert (47%). Patients in the three-hour resuscitation group required vasopressors at a 29% higher rate than those in the 24-hour resuscitation group, who were identified and resuscitated prior to the BPA alert. Among the six remaining patients who were not appropriately resuscitated in either interval (35%), three required vasopressors (50%). Only one of the 17 patients expired within three days of the BPA alert while being full code. This patient was among the six who were never appropriately resuscitated (17%).Our analysis highlights gaps in adherence to the Surviving Sepsis Campaign guidelines following SIRS BPA alerts. We demonstrated a reduction in the need for vasopressors in a small sample of patients who were identified and resuscitated prior to meeting criteria for shock compared to those resuscitated only after the alert was triggered.

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