A survey of clinicians addressing the approach to the management of severe sepsis and septic shock in the United States

Journal of Critical Care
Svetolik DjurkovicMarilyn T Haupt

Abstract

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. 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. 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). We observe that adherence with SSC guidelines continues to be a challenge for CCM, IM, and EM physicians. Significant differences in manage...Continue Reading

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Jan 21, 2017·Journal of Clinical Epidemiology·Melina L WillsonUNKNOWN Guidelines International Network Implementation Working Group
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