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A survey of clinicians addressing the approach to the management of severe sepsis and septic shock in the United States.
J Crit Care. 2010 Dec; 25(4):658.e1-6.JC

Abstract

PURPOSE

Mortality in severe sepsis and septic shock (SS/SS) remains high. Surviving Sepsis Campaign (SSC) guidelines were published in 2004 with the goal of improving outcomes in SS/SS. We tested the hypothesis that adherence to SSC guidelines and management of patients with SS/SS were influenced by physician specialty.

MATERIALS AND METHODS

A survey was mailed to 4998 randomly selected physicians, 1666 each for emergency medicine (EM), critical care medicine (CCM), and internal medicine (IM) from the American Medical Association database. Demographics, compliance with SSC guidelines, and approaches to management of patients with SS/SS were analyzed by specialty.

RESULTS

Four hundred ninety-nine respondents were included for final analysis. There were no differences between 3 specialties in obtaining blood cultures and in administering intravenous fluids, pressors, and antibiotics. The CCM physicians were more likely to measure serum lactate and central venous pressure, use corticosteroids and drotrecogin α, and aim for normoglycemia and plateau pressures less than 30 cm H(2)O in mechanically ventilated patients (all P < .001).

CONCLUSIONS

We observe that adherence with SSC guidelines continues to be a challenge for CCM, IM, and EM physicians. Significant differences in management of SS/SS exist for the 3 specialties. Because guideline implementation impacts patient outcomes, further evaluation of these differences is warranted.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Djurkovic S
Geisinger Medical Center, Danville, PA 17822, USA. sdjurkovic1@gesinger.edu
Baracaldo JC
No affiliation info available
Guerra JA
No affiliation info available
Sartorius J
No affiliation info available
Haupt MT
No affiliation info available

MeSH

Critical CareEducation, MedicalEducation, Medical, ContinuingEmergency MedicineGuideline AdherenceHumansInternal MedicinePractice Guidelines as TopicPractice Patterns, Physicians'Professional Practice LocationSepsisShock, SepticSurveys and QuestionnairesUnited States

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20646900

Citation

Djurkovic, Svetolik, et al. "A Survey of Clinicians Addressing the Approach to the Management of Severe Sepsis and Septic Shock in the United States." Journal of Critical Care, vol. 25, no. 4, 2010, pp. 658.e1-6.
Djurkovic S, Baracaldo JC, Guerra JA, et al. A survey of clinicians addressing the approach to the management of severe sepsis and septic shock in the United States. J Crit Care. 2010;25(4):658.e1-6.
Djurkovic, S., Baracaldo, J. C., Guerra, J. A., Sartorius, J., & Haupt, M. T. (2010). A survey of clinicians addressing the approach to the management of severe sepsis and septic shock in the United States. Journal of Critical Care, 25(4), e1-6. https://doi.org/10.1016/j.jcrc.2010.04.005
Djurkovic S, et al. A Survey of Clinicians Addressing the Approach to the Management of Severe Sepsis and Septic Shock in the United States. J Crit Care. 2010;25(4):658.e1-6. PubMed PMID: 20646900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A survey of clinicians addressing the approach to the management of severe sepsis and septic shock in the United States. AU - Djurkovic,Svetolik, AU - Baracaldo,Juan C, AU - Guerra,Jose A, AU - Sartorius,Jennifer, AU - Haupt,Marilyn T, Y1 - 2010/06/19/ PY - 2009/12/18/received PY - 2010/04/01/revised PY - 2010/04/14/accepted PY - 2010/7/22/entrez PY - 2010/7/22/pubmed PY - 2011/1/11/medline SP - 658.e1 EP - 6 JF - Journal of critical care JO - J Crit Care VL - 25 IS - 4 N2 - PURPOSE: Mortality in severe sepsis and septic shock (SS/SS) remains high. Surviving Sepsis Campaign (SSC) guidelines were published in 2004 with the goal of improving outcomes in SS/SS. We tested the hypothesis that adherence to SSC guidelines and management of patients with SS/SS were influenced by physician specialty. MATERIALS AND METHODS: A survey was mailed to 4998 randomly selected physicians, 1666 each for emergency medicine (EM), critical care medicine (CCM), and internal medicine (IM) from the American Medical Association database. Demographics, compliance with SSC guidelines, and approaches to management of patients with SS/SS were analyzed by specialty. RESULTS: Four hundred ninety-nine respondents were included for final analysis. There were no differences between 3 specialties in obtaining blood cultures and in administering intravenous fluids, pressors, and antibiotics. The CCM physicians were more likely to measure serum lactate and central venous pressure, use corticosteroids and drotrecogin α, and aim for normoglycemia and plateau pressures less than 30 cm H(2)O in mechanically ventilated patients (all P < .001). CONCLUSIONS: We observe that adherence with SSC guidelines continues to be a challenge for CCM, IM, and EM physicians. Significant differences in management of SS/SS exist for the 3 specialties. Because guideline implementation impacts patient outcomes, further evaluation of these differences is warranted. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/20646900/A_survey_of_clinicians_addressing_the_approach_to_the_management_of_severe_sepsis_and_septic_shock_in_the_United_States_ DB - PRIME DP - Unbound Medicine ER -