Results from the National Sepsis Practice Survey: use of drotrecogin α (activated) and other therapeutic decisions.
OBJECTIVE
We sought to evaluate factors associated with choices about provided care for patients with septic shock, including the use of drotrecogin α (activated) (DAA).


METHODS
We administered a mail-based survey to a random sample of intensivists. Study vignettes presented patients with septic shock with identical severity of illness scores but different ages, body mass indices, and comorbidities. Respondents estimated outcomes and selected care beyond standardized initial care (eg, antibiotics) for each hypothetical patient.


RESULTS
For most vignettes (99.1%), respondents added care, most commonly low tidal volume ventilation (87.6%) and enteral nutrition (73.3%). Choosing to administer DAA was not associated with predictions about mortality or bleeding. Vignettes with early-stage lung cancer were less likely to receive DAA. Time since medical school graduation was also associated with lower odds of selecting DAA. Most respondents (52.6%) chose identical care for all 4 completed vignettes.


CONCLUSIONS
There was wide variability in the therapeutic choices of respondents. The use of DAA was not associated with perceived risk of mortality or bleeding, as recommended by consensus guidelines. Physicians appear to base treatment decisions in septic shock on a consistent pattern of practice rather than estimates of patient outcome.
O'Brien
James M
JM
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Center for Critical Care, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH 43210, USA. james.obrien@osumc.edu
Aberegg
Scott K
SK
Ali
Naeem A
NA
Diette
Gregory B
GB
Lemeshow
Stanley
S
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002755:Choice Behavior; D003422:Critical Care; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D018570:Risk Assessment; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States
D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated