RT Journal Article
SR Electronic
T1 Variability in management of early severe sepsis
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 110
OP 115
DO 10.1136/emj.2008.070912
VO 27
IS 2
A1 Michael C Reade
A1 David T Huang
A1 Derek Bell
A1 Timothy J Coats
A1 Anthony M Cross
A1 John L Moran
A1 Sandra L Peake
A1 Mervyn Singer
A1 Donald M Yealy
A1 Derek C Angus
YR 2010
UL http://emj.bmj.com/content/27/2/110.abstract
AB 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.