Effect of Implementing A clinical Sepsis Pathway on Lactate Level among Critically Ill Patients

The introduction and implementation of clinical pathway for the management of sepsis in critically ill patients was associated with significant improvement of outcomes especially when led by nurses. Nurses continuously assess, analyze, interpret, care, and monitor for their patients. In a general ICU population, basal lactate concentration predicted the risk of death with a good accuracy. Objective: determine effect of implementing a clinical sepsis pathway on lactate level among critically ill patients. Research hypothesis: Critically ill patients with sepsis who are subjected to the clinical pathway exhibit lactate level lower than those who not subjected. Methodology: A quasi experimental research design was used to conduct this study. Setting: at the department of the emergency department units namely reception and resuscitation unit at Alexandria Main University Hospital. Sampling: A convenience sample of 80 newly admitted critically ill adult patients (18 to 60 years) constituted the subjects for this study. The sample was equally assigned into two equal groups (40 patients in each): group "A" the control group were subjected to unit routine care and group "B", the study group were subjected to the clinical pathway. Tool: One tool was utilized to collect the data of this study. This tool was adapted by the researcher from Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2016. Results: mean arterial lactate concentrations were lowered in the study group more than in the control group at each studied time (3.6 ± 2.9 vs. 6.27 ± 4.01 after 2 hours; 2.7 ± 3.03 vs. 6.41 ± 4.5 after 4 hours and 1.9 ± 2.93 vs. 3.1 ± 3.2 after 2 hours with statistical significance difference between the two groups for each studied time p= 0.011, >0.001, and >0.001 correspondingly).Conclusions: serum lactate level at 6 hours can be an easier and more effective tool for prognosis of septic shock patients who were treated with clinical pathway and protocol-driven resuscitation bundle therapy.