Murdoch Leeies1, Hayley B Gershengorn2,3,4, Emmanuel Charbonney5, Anand Kumar6, Dean Fergusson7,8,9, Alexis F Turgeon10,11, Juthaporn Cowan12, Bojan Paunovic13, John Embil14, Allan Garland13, Donald S Houston15, Brett Houston15, Emily Rimmer15, Faisal Siddiqui16, Bill Cameron17, Srinivas Murthy18, John C Marshall19, Rob Fowler20, Ryan Zarychanski13,15. 1. Department of Emergency Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada. mleeies@hsc.mb.ca. 2. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miami, FL, USA. 3. School of Medicine, Miami, FL, USA. 4. Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. 5. Department of Medicine, Critical Care, Université de Montréal, Montreal, QC, Canada. 6. Department of Medical Microbiology, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada. 7. Departments of Medicine, Surgery, Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 8. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. 9. Canadian Blood Services, Ottawa, Canada. 10. CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Québec City, QC, Canada. 11. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada. 12. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 13. Department of Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada. 14. Department of Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada. 15. Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada. 16. Department of Anesthesiology, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada. 17. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. 18. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. 19. Department of Surgery, University of Toronto, Toronto, ON, Canada. 20. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Abstract
PURPOSE: This national survey evaluated the perceived efficacy and safety of intravenous immune globulin (IVIG) in septic shock, self-reported utilization patterns, barriers to use, the population of interest for further trials and willingness to participate in future research of IVIG in septic shock. METHODS: We conducted a cross-sectional survey of critical care and infectious diseases physicians across Canada. We summarized categorical item responses as counts and proportions. We developed a multivariable logistic regression model to identify physician-level predictors of IVIG use in septic shock. RESULTS: Our survey was disseminated to 674 eligible respondents with a final response rate of 60%. Most (91%) respondents reported having prescribed IVIG to patients with septic shock at least once, 86% for septic shock due to necrotizing fasciitis, 52% for other bacterial toxin-mediated causes of septic shock, and 5% for undifferentiated septic shock. The majority of respondents expressed uncertainty regarding the impact of IVIG on mortality (97%) and safety (95%) in septic shock. Respondents were willing to participate in further IVIG research with 98% stating they would consider enrolling their patients into a trial of IVIG in septic shock. Familiarity with published evidence was the single greatest predictor of IVIG use in septic shock (odds ratio, 10.2; 95% confidence interval, 3.4 to 30.5; P < 0.001). CONCLUSIONS: Most Canadian critical care and infectious diseases specialist physicians reported previous experience using IVIG in septic shock. Respondents identified inadequacy of existing research as the greatest barrier to routine use of IVIG in septic shock. Most respondents support the need for further studies on IVIG in septic shock, and would consider enrolling their own patients into a trial of IVIG in septic shock.
PURPOSE: This national survey evaluated the perceived efficacy and safety of intravenous immune globulin (IVIG) in septic shock, self-reported utilization patterns, barriers to use, the population of interest for further trials and willingness to participate in future research of IVIG in septic shock. METHODS: We conducted a cross-sectional survey of critical care and infectious diseases physicians across Canada. We summarized categorical item responses as counts and proportions. We developed a multivariable logistic regression model to identify physician-level predictors of IVIG use in septic shock. RESULTS: Our survey was disseminated to 674 eligible respondents with a final response rate of 60%. Most (91%) respondents reported having prescribed IVIG to patients with septic shock at least once, 86% for septic shock due to necrotizing fasciitis, 52% for other bacterial toxin-mediated causes of septic shock, and 5% for undifferentiated septic shock. The majority of respondents expressed uncertainty regarding the impact of IVIG on mortality (97%) and safety (95%) in septic shock. Respondents were willing to participate in further IVIG research with 98% stating they would consider enrolling their patients into a trial of IVIG in septic shock. Familiarity with published evidence was the single greatest predictor of IVIG use in septic shock (odds ratio, 10.2; 95% confidence interval, 3.4 to 30.5; P < 0.001). CONCLUSIONS: Most Canadian critical care and infectious diseases specialist physicians reported previous experience using IVIG in septic shock. Respondents identified inadequacy of existing research as the greatest barrier to routine use of IVIG in septic shock. Most respondents support the need for further studies on IVIG in septic shock, and would consider enrolling their own patients into a trial of IVIG in septic shock.
Authors: Rachel A Nakash; Jane L Hutton; Ellen C Jørstad-Stein; Simon Gates; Sarah E Lamb Journal: BMC Med Res Methodol Date: 2006-02-23 Impact factor: 4.615
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Authors: Philip James Edwards; Ian Roberts; Mike J Clarke; Carolyn Diguiseppi; Reinhard Wentz; Irene Kwan; Rachel Cooper; Lambert M Felix; Sarah Pratap Journal: Cochrane Database Syst Rev Date: 2009-07-08