Eden Bitton1, Shmuel Zimmerman1, Luciano Cesar Pontes Azevedo2, Dan Benhamou3, Maurizio Cecconi4, Jan J De Waele5, Jeffrey Lipman6, Ignacio Martin-Loeches7, Romain Pirracchio8, Thomas W L Scheeren9, Marc Leone10, Sharon Einav1. 1. Intensive Care Unit of the Shaare Zedek Medical Center and the Hebrew University Faculty of Medicine, Jerusalem, Israel. 2. Emergency Medicine Department, University of São Paulo, School of Medicine, São Paulo, Brazil. 3. Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Saclay, Le Kremlin Bicêtre Cedex, France. 4. Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. 5. Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium. 6. Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia; The University of Queensland, Saint Lucia, Australia; Jamieson Trauma Institute, Saint Lucia, Australia; Nimes University Hospital, University of Montpellier, Montpellier, France. 7. Department of Clinical Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital & Trinity Centre for Health Sciences, Dublin, Ireland. 8. Department of Anaesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Centre, University of California San Francisco, San Francisco, California, United States. 9. Department of Anaesthesiology, University Medical Centre Groningen, Groningen, The Netherlands. 10. Aix Marseille University, Hôpitaux Universitaires de Marseille, Department of Anesthesiology and Intensive Care, Hospital Nord, Marseille, France. Electronic address: marc.leone@ap-hm.fr.
Abstract
BACKGROUND: Our survey aimed to evaluate adherence to Surviving Sepsis Campaign (SSC) Guidelines 2016 among intensive care practitioners and to identify issues that remain controversial or lack clarity. METHODS: Members of the European Society of Intensive Care Medicine (ESICM) were surveyed using an anonymous web-based survey written by an international group of experts. The primary outcome measure was the rate of adherence to specific recommendations. Secondary outcomes were to describe areas of controversy and lack of data and to associate specific practices with clinician characteristics. RESULTS: Overall 820 questionnaires were completed. The SCC recommendations 2016 most adhered to were the choice of norepinephrine as first-line vasoactive drug (96.5%), vasopressor prescription based on therapeutic goal rather than dose (83.4%), targeting a specific mean arterial blood pressure during vasopressor use (77.9%), monitoring of blood pressure invasively (62.8%) and adding vasopressin or epinephrine as a second vasoactive agent (83.4%). We identified an internal conflict with regards to parallel versus sequential administration of fluids and vasoactive drugs and regional differences in practice that may be related to drug availabilities. CONCLUSION: The use of vasopressors and fluid use in septic shock is largely compliant with current guidelines but several controversies should be addressed in future guideline iterations.
BACKGROUND: Our survey aimed to evaluate adherence to Surviving Sepsis Campaign (SSC) Guidelines 2016 among intensive care practitioners and to identify issues that remain controversial or lack clarity. METHODS: Members of the European Society of Intensive Care Medicine (ESICM) were surveyed using an anonymous web-based survey written by an international group of experts. The primary outcome measure was the rate of adherence to specific recommendations. Secondary outcomes were to describe areas of controversy and lack of data and to associate specific practices with clinician characteristics. RESULTS: Overall 820 questionnaires were completed. The SCC recommendations 2016 most adhered to were the choice of norepinephrine as first-line vasoactive drug (96.5%), vasopressor prescription based on therapeutic goal rather than dose (83.4%), targeting a specific mean arterial blood pressure during vasopressor use (77.9%), monitoring of blood pressure invasively (62.8%) and adding vasopressin or epinephrine as a second vasoactive agent (83.4%). We identified an internal conflict with regards to parallel versus sequential administration of fluids and vasoactive drugs and regional differences in practice that may be related to drug availabilities. CONCLUSION: The use of vasopressors and fluid use in septic shock is largely compliant with current guidelines but several controversies should be addressed in future guideline iterations.