• Alfred Papali, Eoin West T T Division of Pulmonary & Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA; International Respiratory and Severe Illness , Avelino C Verceles, Marc E Augustin, Nathalie Colas L L Department of Medicine, St. Luke Family Hospital, Port-au-Prince, Haiti., Carl H Jean-Francois, Devang M Patel, Nevins W Todd, Michael T McCurdy, and Haiti REsource Limited Intensive Care (Haiti-RELIC) Study Group.
• Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: apapali@som.umaryland.edu.
• J Crit Care. 2017 Oct 1; 41: 222-228.

PurposeThe World Health Organization (WHO) has developed a simplified algorithm specific to resource-limited settings for the treatment of severe sepsis emphasizing early fluids and antibiotics. However, this protocol's clinical effectiveness is unknown. We describe patient outcomes before and after implementation of an adapted WHO severe sepsis protocol at a community hospital in Haiti.Materials And MethodsUsing a before-and-after study design, we retrospectively enrolled 99 adult Emergency Department patients with severe sepsis from January through March 2012. After protocol implementation in January 2014, we compared outcomes to 67 patients with severe sepsis retrospectively enrolled from February to April 2014. We defined sepsis according to the WHO's Integrated Management of Adult Illness guidelines and severe sepsis as sepsis plus organ dysfunction.ResultsAfter protocol implementation, quantity of fluid administered increased and the physician's differential diagnoses more often included sepsis. Patients were more likely to have follow-up vital signs taken sooner, a radiograph performed, and a lactic acid tested. There were no improvements in mortality, time to fluids or antimicrobials.ConclusionsUse of a simplified sepsis protocol based primarily on physiologic parameters allows for substantial improvements in process measures in the care of severely septic patients in a resource-constrained setting.Copyright © 2017 Elsevier Inc. All rights reserved.

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