Acute infection in post-disaster settings complicates clinical course associated with increased mortality. Sepsis management in low resources settings is controversial with recent research suggesting that aggressive fluid resuscitation may cause greater harm than benefit. However the vast majority of international sepsis guidelines still suggest large initial fluid boluses as part of sepsis algorithms.
The aim is to create an adult and pediatric sepsis algorithm to be applied in a low resource clinical setting. This is part of a larger project to create clinical algorithms to provide standardization of emergency case management for low resource clinical environments.
A literature search was performed through PubMed identifying and reviewing fluid resuscitation in adult and pediatric sepsis patients in high and low resource clinical environments. The pathways were created based on interpretation of the available evidence-based literature. Focus groups were conducted in Zambia in March 2018 for feedback from local practitioners regarding feasibility of pathways. The pathways were then modified, reviewed by experts peer-review and revised.
Final pediatric and adult sepsis clinical algorithms were created and posted to the free web-based application AgileMD™. They will be available via app access, an online platform or printable pathways for use in the clinical environment.
The study is currently undergoing IRB approval with plan for implementation of multiple clinical algorithms at a referral hospital site in Zambia in January 2019. Site direction at Ndola Hospital will be conducted under the leadership of an Emergency Medicine trained physician, who will assist in implementation of algorithms and collection of data. Initial data review will be conducted in May 2019. There will be incremental site visits by organizing researchers throughout the implementation and data collection period. Statistical analysis will examine sepsis associated process and outcome indicators pre and post intervention to further delineate sepsis management in low resource clinical environments.