A "three delays" model for severe sepsis in resource-limited countries

J Crit Care. 2015 Aug;30(4):861.e9-14. doi: 10.1016/j.jcrc.2015.04.003. Epub 2015 Apr 16.

Abstract

Purpose: The developing world carries the greatest burden of sepsis-related mortality, but success in managing severe sepsis in resource-limited countries (RLCs) remains challenging. A "three delays" model has been developed to describe factors influencing perinatal mortality in developing nations. This model has been validated across different World Health Organization regions and has provided the framework for policymakers to plan targeted interventions. Here, we propose a three delays model for severe sepsis in RLCs.

Materials and methods: A literature review was performed using the PubMed, Google Scholar, and Ovid databases. Additional sources were found after review of the reference lists from retrieved articles.

Results: We propose a three delays model for severe sepsis in adults in RLCs. The model highlights limitations in the 3 basic pillars of sepsis management: (1) sepsis recognition and diagnosis at the time of triage, (2) initial focused resuscitation, and (3) postresuscitation clinical monitoring and reassessment.

Conclusions: Characterizing the major barriers to effective treatment of severe sepsis in RLCs frames the problem in a language common to global health circles, which may stimulate further research, streamline treatment, and reduce sepsis-related mortality in the developing world.

Keywords: Critical care; Developing country; Global health; Intensive care; Resource-limited; Sepsis.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Clinical Competence
  • Critical Care
  • Delayed Diagnosis / statistics & numerical data*
  • Developing Countries*
  • Fluid Therapy / methods
  • Health Care Costs
  • Health Literacy
  • Health Resources*
  • Health Services Accessibility
  • Humans
  • Models, Theoretical
  • Oxygen Inhalation Therapy / methods
  • Resuscitation / statistics & numerical data
  • Risk Factors
  • Sepsis / diagnosis*
  • Sepsis / mortality
  • Sepsis / therapy
  • Time Factors
  • Time-to-Treatment / statistics & numerical data*
  • Triage

Substances

  • Anti-Bacterial Agents