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Practice and perception--a nationwide survey of therapy habits in sepsis.
Crit Care Med. 2008 Oct; 36(10):2719-25.CC

Abstract

OBJECTIVE

To simultaneously determine perceived vs. practiced adherence to recommended interventions for the treatment of severe sepsis or septic shock.

DESIGN

One-day cross-sectional survey.

SETTING

Representative sample of German intensive care units stratified by hospital size.

PATIENTS

Adult patients with severe sepsis or septic shock.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Practice recommendations were selected by German Sepsis Competence Network (SepNet) investigators. External intensivists visited intensive care units randomly chosen and asked the responsible intensive care unit director how often these recommendations were used. Responses "always" and "frequently" were combined to depict perceived adherence. Thereafter patient files were audited. Three hundred sixty-six patients on 214 intensive care units fulfilled the criteria and received full support. One hundred fifty-two patients had acute lung injury or acute respiratory distress syndrome. Low-tidal volume ventilation < or = 6 mL/kg/predicted body weight was documented in 2.6% of these patients. A total of 17.1% patients had tidal volume between 6 and 8 mL/kg predicted body weight and 80.3% > 8 mL/kg predicted body weight. Mean tidal volume was 10.0 +/- 2.4 mL/kg predicted body weight. Perceived adherence to low-tidal volume ventilation was 79.9%. Euglycemia (4.4-6.1 mmol/L) was documented in 6.2% of 355 patients. A total of 33.8% of patients had blood glucose levels < or = 8.3 mmol/L and 66.2% were hyperglycemic (blood glucose > 8.3 mmol/L). Among 207 patients receiving insulin therapy, 1.9% were euglycemic, 20.8% had blood glucose levels < or = 8.3 mmol/L, and 1.0% were hypoglycemic. Overall, mean maximal glucose level was 10.0 +/- 3.6 mmol/L. Perceived adherence to strict glycemic control was 65.9%. Although perceived adherence to recommendations was higher in academic and larger hospitals, actual practice was not significantly influenced by hospital size or university affiliation.

CONCLUSIONS

This representative survey shows that current therapy of severe sepsis in German intensive care units complies poorly with practice recommendations. Intensive care unit directors perceive adherence to be higher than it actually is. Implementation strategies involving all intensive care unit staff are needed to overcome this gap between current evidence-based knowledge, practice, and perception.

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Authors+Show Affiliations

Brunkhorst FM
Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University Jena, Germany.
Engel C
No affiliation info available
Ragaller M
No affiliation info available
Welte T
No affiliation info available
Rossaint R
No affiliation info available
Gerlach H
No affiliation info available
Mayer K
No affiliation info available
John S
No affiliation info available
Stuber F
No affiliation info available
Weiler N
No affiliation info available
Oppert M
No affiliation info available
Moerer O
No affiliation info available
Bogatsch H
No affiliation info available
Reinhart K
No affiliation info available
Loeffler M
No affiliation info available
Hartog C
No affiliation info available
German Sepsis Competence Network (SepNet)
No affiliation info available

MeSH

APACHEAdultAgedAttitude of Health PersonnelBlood GlucoseCombined Modality TherapyCritical CareCritical IllnessCross-Sectional StudiesFemaleGermanyGuideline AdherenceHospital MortalityHumansIntensive Care UnitsMaleMiddle AgedNeeds AssessmentPractice Guidelines as TopicProbabilityQuality of Health CareRespiratory Distress SyndromeSepsisShock, SepticSurvival AnalysisTidal VolumeTreatment Outcome

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18766100

Citation

Brunkhorst, Frank M., et al. "Practice and Perception--a Nationwide Survey of Therapy Habits in Sepsis." Critical Care Medicine, vol. 36, no. 10, 2008, pp. 2719-25.
Brunkhorst FM, Engel C, Ragaller M, et al. Practice and perception--a nationwide survey of therapy habits in sepsis. Crit Care Med. 2008;36(10):2719-25.
Brunkhorst, F. M., Engel, C., Ragaller, M., Welte, T., Rossaint, R., Gerlach, H., Mayer, K., John, S., Stuber, F., Weiler, N., Oppert, M., Moerer, O., Bogatsch, H., Reinhart, K., Loeffler, M., & Hartog, C. (2008). Practice and perception--a nationwide survey of therapy habits in sepsis. Critical Care Medicine, 36(10), 2719-25. https://doi.org/10.1097/CCM.0b013e318186b6f3
Brunkhorst FM, et al. Practice and Perception--a Nationwide Survey of Therapy Habits in Sepsis. Crit Care Med. 2008;36(10):2719-25. PubMed PMID: 18766100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Practice and perception--a nationwide survey of therapy habits in sepsis. AU - Brunkhorst,Frank M, AU - Engel,Christoph, AU - Ragaller,Max, AU - Welte,Tobias, AU - Rossaint,Rolf, AU - Gerlach,Herwig, AU - Mayer,Konstantin, AU - John,Stefan, AU - Stuber,Frank, AU - Weiler,Norbert, AU - Oppert,Michael, AU - Moerer,Onnen, AU - Bogatsch,Holger, AU - Reinhart,Konrad, AU - Loeffler,Markus, AU - Hartog,Christiane, AU - ,, PY - 2008/9/4/pubmed PY - 2008/10/29/medline PY - 2008/9/4/entrez SP - 2719 EP - 25 JF - Critical care medicine JO - Crit Care Med VL - 36 IS - 10 N2 - OBJECTIVE: To simultaneously determine perceived vs. practiced adherence to recommended interventions for the treatment of severe sepsis or septic shock. DESIGN: One-day cross-sectional survey. SETTING: Representative sample of German intensive care units stratified by hospital size. PATIENTS: Adult patients with severe sepsis or septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Practice recommendations were selected by German Sepsis Competence Network (SepNet) investigators. External intensivists visited intensive care units randomly chosen and asked the responsible intensive care unit director how often these recommendations were used. Responses "always" and "frequently" were combined to depict perceived adherence. Thereafter patient files were audited. Three hundred sixty-six patients on 214 intensive care units fulfilled the criteria and received full support. One hundred fifty-two patients had acute lung injury or acute respiratory distress syndrome. Low-tidal volume ventilation < or = 6 mL/kg/predicted body weight was documented in 2.6% of these patients. A total of 17.1% patients had tidal volume between 6 and 8 mL/kg predicted body weight and 80.3% > 8 mL/kg predicted body weight. Mean tidal volume was 10.0 +/- 2.4 mL/kg predicted body weight. Perceived adherence to low-tidal volume ventilation was 79.9%. Euglycemia (4.4-6.1 mmol/L) was documented in 6.2% of 355 patients. A total of 33.8% of patients had blood glucose levels < or = 8.3 mmol/L and 66.2% were hyperglycemic (blood glucose > 8.3 mmol/L). Among 207 patients receiving insulin therapy, 1.9% were euglycemic, 20.8% had blood glucose levels < or = 8.3 mmol/L, and 1.0% were hypoglycemic. Overall, mean maximal glucose level was 10.0 +/- 3.6 mmol/L. Perceived adherence to strict glycemic control was 65.9%. Although perceived adherence to recommendations was higher in academic and larger hospitals, actual practice was not significantly influenced by hospital size or university affiliation. CONCLUSIONS: This representative survey shows that current therapy of severe sepsis in German intensive care units complies poorly with practice recommendations. Intensive care unit directors perceive adherence to be higher than it actually is. Implementation strategies involving all intensive care unit staff are needed to overcome this gap between current evidence-based knowledge, practice, and perception. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/18766100/Practice_and_perception__a_nationwide_survey_of_therapy_habits_in_sepsis_ L2 - https://dx.doi.org/10.1097/CCM.0b013e318186b6f3 DB - PRIME DP - Unbound Medicine ER -