The clinical issue I decided on, was patients with sepsis and chronic kidney disease (CKD), especially those on dialysis. CKD are at a higher risk of developing sepsis due to their weakened immunity. Sepsis contributes significantly to morbidity, mortality, and prolonged hospitalization in this population, making early recognition and protocol management essential (Chen et al., 2020).QuestionIn adult patients with chronic kidney does implementation of sepsis bundle or early goal directed therapy, compared to usual standard care to reduce mortality rate and/or length of ICU stay during hospitalization.Database SearchUsing the Walden University Library through EBSCOhost, I searched database CINAHL Plus, Medline, and Academic Search Complete. In my initial search of sepsis, over 24,000 results appeared. After adding AND in the Boolean operator with kidney disease, more than 1,100 which many were review articles. After adding CKD, ESRD, or dialysis in Boolean operators, the results came to 325 articles and 72 were identified as original search. Applying filters like peer reviewed and published within the past 5 years. In this search, results went down to 44 highly relevant articles. With the CINAHL search using headings such as sepsis and renal insufficiency retrieved more precise studies. This process showed how Boolean operators, vocabulary, and filters improved the quality of the search and minimized irrelevant results. For example, one nationwide study found that CKD significantly increased mortality risk in patients with sepsis (Chen et al., 2020). Another cohort analysis analysis showed higher in-hospital mortality among end stage renal disease patients admitted with sepsis (Hsu et al., 2021). Studies have also shown that the sepsis bundle adherence in CKD populations, with findings suggesting improved survival when bundles were followed (Snyder et al., 2021). Early goal directed therapy has been specifically studied in septic patients with preexisting kidney disease, demonstrating reductions in mortality and ICU length of stay (Wu et al., 2020).Strategies Increasing Rigor and EffectivenessBoolean operators and synonyms, using the words sepsis, CKD, ESRD, or dialysis expands the search of locating journal and/or articles that are relevant retrieval. Controlled vocabulary is applying MeSH terms such as “Sepsis” and “CKD in PubMed increases precision. Database filters limits the of peer reviewed, original research, adult, and published within the last 5 years enhances rigor. Iterative refinement allows you to add terms such as mortality, ICU outcomes, or bundle compliance focused results on clinically meaningful outcomes. Citation chaining is a review if references of pivotal studies helped identify additional trials relevant to sepsis in CKD.These strategies are provided a systematic, reproducible process for gathering high quality evidence to support my PICOT inquiry.
ReferencesChen, C. Y., Lin., Y.S., Chen C., H., Chou, W., H., & Hung, C. C., (2020). Impact of chronic kidney disease on mortality risk in patients with sepsis: A nationwide population-based study. PLOS ONE, 15(6).
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