The Influence of Patient Age, Co-Morbidity and Perceived Quality of Life on Compliance with the Sepsis Resuscitation Bundle by Critical Care Physicians

Patients presenting to critical care with severe sepsis are often elderly and have multiple co-morbidities. We constructed four clinical scenarios describing patients compromised to varying degrees by advanced age or co-morbidity and presenting with severe sepsis. Clinicians attending the Northwest Critical Care Symposium in April 2011 were asked to specify the interventions they would offer each patient, after consideration of the clinical information, with regards to components of the sepsis six-hour resuscitation care bundle. In all four scenarios a significant proportion of clinicians would have withheld more invasive measures in the Surviving Sepsis resuscitation bundle such as central venous access, the use of vasopressors and inotropes and admission to a high dependency setting. The majority of clinicians would, however, have offered other standard, less invasive treatment measures to these patients. Clinical judgment relating to age and co-morbidity influences the implementation of the sepsis management bundle and should be taken into account when assessing compliance with the bundle.