The SPREAD conducted by ILAS and the BRICNet, is a multicenter, national character, in order to assess both the prevalence and the mortality rate for severe sepsis and septic shock in Brazilian ICUs. Also sought to evaluate the differences in the prevalence, the adequacy of treatment and mortality in different geographical regions. Moreover, these institutions were characterized with regard to the infrastructure necessary for compliance with sepsis.
For the study were representative of the national reality, strata were created as geo-economic area, geographical location in the capital or interior, the main funding source (SUS hospital or health insurance) and number of ICU beds (<10 beds or> 10 beds) and city size. The following were chosen at random, 13% of ICU beds in each stratum.
The distribution of Brazilian ICU was obtained by consulting the ICU Census of the Brazilian Intensive Medicine Association, in which they are enrolled 1,813 adult ICU patients from all Brazilian regions, totaling 20,731 beds. Responded to resource assessment questionnaire 277 ICUs. These data show that there is low availability of some essential items for the treatment of sepsis, especially in the Northeast and Amazon. This availability was also lower in the necessary public hospitals.
On the day of the study, 229 institutions included 794 patients, corresponding to a prevalence of 29.6%, ie 1/3 of the country ICU beds are occupied by patients with severe sepsis and shock. This shows the heavy burden that sepsis represents to Brazil in terms of allocated resources, including availability of beds.
The overall mortality was 55%. Mortality in the Southeast region was 51.2%, lower than that of other regions (Midwest: 70%, Northeast: 58.3, Southern: 57.8% and North: 57.4%). The mortality of hospitals attached to the National Health System was no different from those linked to the Health Insurance. This lethality is much higher than the reported in developed countries.
The study showed that factors are associated with increased mortality severity of patients, the fact that they acquired their infection when they were admitted to the ICU (hospital infection) and the inadequacy of treatment mainly the delay for the first dose of antibiotics. In addition, institutions with less available resources had higher mortality.
Funding: FAPESP process 2011 / 20401-4
Study Status: Completed. In writing for submission for publication.