{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T16:24:35Z","timestamp":1769185475720,"version":"3.49.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2013,4,23]],"date-time":"2013-04-23T00:00:00Z","timestamp":1366675200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2013,4,23]],"date-time":"2013-04-23T00:00:00Z","timestamp":1366675200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p>Higher compliance with Surviving Sepsis Campaign (SSC) recommendations has been associated with lower mortality. The authors evaluate differences in compliance with SSC 6-hour bundle according to hospital entrance time (day <jats:italic>versus<\/jats:italic> night) and its impact on hospital mortality.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>Prospective cohort study of all patients with community-acquired severe sepsis admitted to the intensive care unit of a large university tertiary care hospital, over 3.5 years with a follow-up until hospital discharge. Time to compliance with each recommendation of the SSC 6-hour bundle was calculated according to hospital entrance period: day (08:30 to 20:30) <jats:italic>versus<\/jats:italic> night (20:30 to 08:30). For the same periods, clinical staff composition and the number of patients attending the emergency department (ED) was also recorded.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>In this period 300 consecutive patients were included. Compliance rate was (night <jats:italic>vs<\/jats:italic>. day): serum lactate measurement 57% <jats:italic>vs<\/jats:italic>. 49% (<jats:italic>P<\/jats:italic> = 0.171), blood cultures drawn 59% <jats:italic>vs<\/jats:italic>. 37% (<jats:italic>P<\/jats:italic> &lt; 0.001), antibiotics administration in the first 3 hours 33% <jats:italic>vs<\/jats:italic>. 18% (<jats:italic>P<\/jats:italic> = 0.003), central venous pressure &gt;8 mmHg 45% <jats:italic>vs<\/jats:italic>. 29% (<jats:italic>P<\/jats:italic> = 0.021), and central venous oxygen saturation (SvcO<jats:sub>2<\/jats:sub>) &gt;70%, 7% <jats:italic>vs<\/jats:italic>. 2% (<jats:italic>P<\/jats:italic> = 0.082); fluids were administered in all patients with hypotension in both periods and vasopressors were administered in patients with hypotension not responsive to fluids in 100% <jats:italic>vs<\/jats:italic>. 99%. Time to get specific actions done was also different (night <jats:italic>vs<\/jats:italic>. day): serum lactate measurement (4.5 <jats:italic>vs<\/jats:italic>. 7 h, <jats:italic>P<\/jats:italic> = 0.018), blood cultures drawn (4 <jats:italic>vs<\/jats:italic>. 8 h, <jats:italic>P<\/jats:italic> &lt; 0.001), antibiotic administration (5 vs. 8 h, <jats:italic>P<\/jats:italic> &lt; 0.001), central venous pressure (8 <jats:italic>vs<\/jats:italic>. 11 h, <jats:italic>P<\/jats:italic> = 0.01), and SvcO<jats:sub>2<\/jats:sub> monitoring (2.5 <jats:italic>vs<\/jats:italic>. 11 h, <jats:italic>P<\/jats:italic> = 0.222). The composition of the nursing team was the same around the clock; the medical team was reduced at night with a higher proportion of less differentiated doctors. The number of patients attending the Emergency Department was lower overnight. Hospital mortality rate was 34% in patients entering in the night period <jats:italic>vs<\/jats:italic>. 40% in those entering during the day (<jats:italic>P<\/jats:italic> = 0.281).<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusion<\/jats:title>\n                        <jats:p>Compliance with SSC recommendations was higher at night. A possible explanation might be the increased nurse to patient ratio in that period. Adjustment of the clinical team composition to the patients' demand is needed to increase compliance and improve prognosis.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/cc12689","type":"journal-article","created":{"date-parts":[[2013,4,23]],"date-time":"2013-04-23T16:15:09Z","timestamp":1366733709000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Differences in compliance with Surviving Sepsis Campaign recommendations according to hospital entrance time: day versus night"],"prefix":"10.1186","volume":"17","author":[{"given":"M\u00f3nica","family":"Almeida","sequence":"first","affiliation":[]},{"given":"Orqu\u00eddea","family":"Ribeiro","sequence":"additional","affiliation":[]},{"given":"Irene","family":"Arag\u00e3o","sequence":"additional","affiliation":[]},{"given":"Altamiro","family":"Costa-Pereira","sequence":"additional","affiliation":[]},{"given":"Teresa","family":"Cardoso","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2013,4,23]]},"reference":[{"key":"1945_CR1","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1164\/rccm.200208-785OC","volume":"168","author":"C Alberti","year":"2003","unstructured":"Alberti C, Brun-Buisson C, Goodman SV, Guidici D, Granton J, Moreno R, Smithies M, Thomas O, Artigas A, Le Gall JR: Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients.\n                           Am J Respir Crit Care Med 2003, 168: 77-84. 10.1164\/rccm.200208-785OC","journal-title":"Am J Respir Crit Care Med"},{"key":"1945_CR2","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1097\/00003246-200107000-00002","volume":"29","author":"DC Angus","year":"2001","unstructured":"Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.\n                           Crit Care Med 2001, 29: 1303-1310. 10.1097\/00003246-200107000-00002","journal-title":"Crit Care Med"},{"key":"1945_CR3","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.jemermed.2006.05.008","volume":"31","author":"M Raghavan","year":"2006","unstructured":"Raghavan M, Marik PE: Management of sepsis during the early \"golden hours\".\n                           J Emerg Med 2006, 31: 185-199. 10.1016\/j.jemermed.2006.05.008","journal-title":"J Emerg Med"},{"key":"1945_CR4","doi-asserted-by":"publisher","first-page":"S595","DOI":"10.1097\/01.CCM.0000147016.53607.C4","volume":"32","author":"MM Levy","year":"2004","unstructured":"Levy MM, Pronovost PJ, Dellinger RP, Townsend S, Resar RK, Clemmer TP, Ramsay G: Sepsis change bundles: converting guidelines into meaningful change in behaviour and clinical outcome.\n                           Crit Care Med 2004, 32: S595-597. 10.1097\/01.CCM.0000147016.53607.C4","journal-title":"Crit Care Med"},{"key":"1945_CR5","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1186\/cc3952","volume":"9","author":"RP Dellinger","year":"2005","unstructured":"Dellinger RP, Vincent JL: The Surviving Sepsis Campaign sepsis change bundles and clinical practice.\n                           Crit Care 2005, 9: 653-654. 10.1186\/cc3952","journal-title":"Crit Care"},{"key":"1945_CR6","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1097\/01.CCM.0000298158.12101.41","volume":"36","author":"RP Dellinger","year":"2008","unstructured":"Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, International Surviving Sepsis Campaign Guidelines Committee; American Association of Critical-Care Nurses; American College of Chest Physicians; American College of Emergency Physicians; Canadian Critical Care Society; Europea Society of Clinical Microbiology and Infectious Diseases, et al.: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.\n                           Crit Care Med 2008, 36: 296-327. 10.1097\/01.CCM.0000298158.12101.41","journal-title":"Crit Care Med"},{"key":"1945_CR7","first-page":"A1","volume-title":"APIC Infection Control and Applied Epidemiology: principles and practice","author":"JS Garner","year":"1996","unstructured":"Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM: CDC definitions for nosocomial infections. 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