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Variability in management of early severe sepsis
  1. Michael C Reade1,2,
  2. David T Huang1,3,
  3. Derek Bell4,
  4. Timothy J Coats5,
  5. Anthony M Cross6,
  6. John L Moran2,
  7. Sandra L Peake2,
  8. Mervyn Singer7,
  9. Donald M Yealy1,3,
  10. Derek C Angus1
  1. 1CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA
  2. 2Australian and New Zealand Intensive Care Society, Carlton, Victoria, Australia
  3. 3Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, USA
  4. 4Society for Acute Medicine, Edinburgh, UK
  5. 5British Association for Emergency Medicine, London, UK
  6. 6Australasian College for Emergency Medicine, West Melbourne, Victoria, Australia
  7. 7Intensive Care Society, London, UK
  1. Correspondence to Dr Michael C Reade, Department of Intensive Care Medicine, Austin Hospital, University of Melbourne, 145 Studley Road, Heidelberg, Victoria 3084, Australia; michael.reade{at}austin.org.au

Abstract

Objective A study was undertaken to characterise how doctors in emergency medicine (EM), acute medicine (AM) and critical care (ICU) in the UK, USA and Australia and New Zealand (ANZ) approach the initial resuscitative care of patients with severe sepsis.

Methods In 2007, members on the mailing lists of UK, US and ANZ EM, ICU and AM specialist organisations were invited to answer an anonymous scenario-based online survey. Respondents described their management of a patient with pneumonia and signs of sepsis. Multiple-choice questions were based on the Surviving Sepsis Campaign (SSC) 6-hour resuscitation bundle guidelines while avoiding the specific terms “sepsis” and “SSC guidelines”.

Results The response rate was 21% (2461/11 795). Only two respondents (0.1%) complied with all SSC resuscitation recommendations. Inter-specialty and inter-country variations included differences in reporting initial lactate measurement (ranging from 30% in US-EM to 79% in UK-EM), fluid resuscitation targeting a central venous pressure of 8–12 mm Hg (from 15% in ANZ-ICU to 60% in UK-EM), blood transfusion for a central venous oxygen saturation <70% and haematocrit <30% (from 15% in ANZ-ICU to 70% in US-EM and UK-EM) and insertion of invasive monitoring (intra-arterial catheter: 89% in UK-ICU vs 20% in US-EM; central venous catheter: 83% in UK-ICU vs 44% in US-EM). 81% of respondents identified at least one reason why they did not implement all the recommendations; the reasons varied by region and specialty.

Conclusions Reported management of early sepsis varies between specialities and countries, and the responses do not follow SSC guidelines. Concerns relate to knowledge, attitudes and resources.

  • Shock, septic
  • sepsis
  • questionnaires
  • clinical protocols
  • early goal directed therapy
  • intensive care
  • paramedics, guidelines
  • respiratory, pneumonia/infections
  • resuscitation

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Footnotes

  • Supplementary figures and tables are published online only at http://emj.bmj.com/content/vol27/issue2

  • Funding The ProCESS investigators are funded by a P50 award from the National Institute of General Medical Sciences of the United States (NIH GM076659). The ARISE investigators are funded by a grant from the Australian National Health and Medical Research Council (491075). With the assistance of the above-named specialty societies in their respective countries, this work was performed principally at the University of Pittsburgh.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Pittsburgh research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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