A survey of clinicians addressing the approach to the management of severe sepsis and septic shock in the United States.
OBJECTIVE
Mortality in severe sepsis and septic shock (SS/SS) remains high. Surviving Sepsis Campaign (SSC) guidelines were published in 2004 with the goal of improving outcomes in SS/SS. We tested the hypothesis that adherence to SSC guidelines and management of patients with SS/SS were influenced by physician specialty.


METHODS
A survey was mailed to 4998 randomly selected physicians, 1666 each for emergency medicine (EM), critical care medicine (CCM), and internal medicine (IM) from the American Medical Association database. Demographics, compliance with SSC guidelines, and approaches to management of patients with SS/SS were analyzed by specialty.


RESULTS
Four hundred ninety-nine respondents were included for final analysis. There were no differences between 3 specialties in obtaining blood cultures and in administering intravenous fluids, pressors, and antibiotics. The CCM physicians were more likely to measure serum lactate and central venous pressure, use corticosteroids and drotrecogin α, and aim for normoglycemia and plateau pressures less than 30 cm H(2)O in mechanically ventilated patients (all P < .001).


CONCLUSIONS
We observe that adherence with SSC guidelines continues to be a challenge for CCM, IM, and EM physicians. Significant differences in management of SS/SS exist for the 3 specialties. Because guideline implementation impacts patient outcomes, further evaluation of these differences is warranted.
Djurkovic
Svetolik
S
Geisinger Medical Center, Danville, PA 17822, USA. sdjurkovic1@gesinger.edu
Baracaldo
Juan C
JC
Guerra
Jose A
JA
Sartorius
Jennifer
J
Haupt
Marilyn T
MT
D003422:Critical Care; D004501:Education, Medical; D004502:Education, Medical, Continuing; D004635:Emergency Medicine; D019983:Guideline Adherence; D006801:Humans; D007388:Internal Medicine; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011365:Professional Practice Location; D018805:Sepsis / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States