PURPOSE: Evidence based guidelines for the treatment of severe sepsis/septic shock (SS/SS) were developed in 2004 by the Surviving Sepsis Campaign (SSC) and have been widely publicized in critical care medicine forums. We tested the hypothesis that there were differences in guideline implementation between Critical Care Medicine (CCM) physicians and physicians who care for patients with SS/SS other than CCM physicians.
METHODS: We randomly selected 4998 physicians; 1666 each for Emergency Medicine (EM), Internal Medicine (IM) and CCM from the AMA Masterfile database. A survey designed to determine demographic information and treatment patterns for SS/SS was sent to each physician. 499 surveys (42% CCM, 42% EM, 16% IM) were returned.
RESULTS: CCM physicians were significantly more likely then EM and IM physicansto to come from large hospitals (>500 beds) with large ICU's (>16 beds) and “closed” staffing patterns (all p< 0.01) and educational institutions (p< 0.04). There were no statistically significant differences between CCM, IM and EM in obtaining blood cultures prior to antibiotic administration, administrating antimicrobials within 1 hour and administration of intravenous fluids and vasopressors. CCM responders were more likely to obtain lactate level, measure CVP, ScvO2, administer drotrecogin alpha, maintain normoglycemia and appropriate inspiratory PlP (all p<0.001). 83% of EM, 46% of IM and 21% of CCM physicians never or almost never used drotrecogin alpha(p<0.001). The most common reason for not using drotrecogin alpha was lack of familiarity with it for EM physicians, restricted institution policy for CCM physicians, and concern about the safety profile for IM physicians.
CONCLUSION: We report significant differences in the management of patients with SS/SS and adherence to SSC Guidelines between CCM, IM and EM physicians. Nevertheless, all specialties followed important basics of sepsis management (blood cultures before antibiotics, early antibiotics, fluids, and vasopressors if needed after fluids).
CLINICAL IMPLICATIONS: Working environments, specialty background, and educational resources influence adherance with guidelines for the treatment of patients with SS/SS. These parameters should be considered when studying strategies to improve adherance with guidelines.
DISCLOSURE: Juan Baracaldo, No Financial Disclosure Information; No Product/Research Disclosure Information