title: Current approach to the haemodynamic management of septic shock patients in European intensive care units: a cross-sectional, self-reported questionnaire-based survey.
abstract: OBJECTIVE
  The aim of this survey was to investigate clinicians' current approach to the haemodynamic management and resuscitation endpoints in septic shock.
  
  
  METHODS
  This cross-sectional, self-reported questionnaire-based survey was sent to the clinical director of selected ICUs in 16 European countries. The questionnaire consisted of two parts and 25 questions. The first part retrieved general information on the hospital and ICU, and the second part of the questionnaire collected detailed information on the approach to haemodynamic management of septic shock.
  
  
  RESULTS
  Of 481 clinicians invited to participate, 237 (49.3%) responded. Ninety-two questionnaires were excluded because of more than 20% missing responses, rendering 145 (30.1%) for statistical analysis. Administration of albumin (P = 0.007), gelatine preparations (P = 0.002), Ringer's solution (P = 0.02) and isotonic saline (P = 0.001) for fluid resuscitation varied between respondents from different countries. Further differences between respondents from different countries were observed for the choice of the first-line inotropic drug (P < 0.001), use of supplementary vasopressin (P = 0.02), supplementary fludrocortisone (P = 0.05) and measurement of cardiac output with the transpulmonary thermodilution (P = 0.001), lithium dilution (P = 0.004) and oesophageal Doppler (P = 0.005) technique. Mean arterial blood pressure (87%), central venous oxygen saturation (65%), central venous pressure (59%), systolic arterial blood pressure (48%), mixed venous oxygen saturation (42%) and cardiac index (42%) were the six haemodynamic variables most commonly claimed to be used as resuscitation endpoints.
  
  
  CONCLUSIONS
  The current approach to the haemodynamic management of septic shock patients in a selected cohort of European ICU clinicians is in agreement with the Surviving Sepsis Campaign guidelines with the exception of the haemodynamic goals.
authors.affiliation: Department of Intensive Care Medicine, Inselspital Bern, Bern, Switzerland. christian-erik.torgersen@insel.ch
authors.forename: Christian
authors.initials: C
authors.lastname: Torgersen
authors.forename: Martin W
authors.initials: MW
authors.lastname: Dünser
authors.forename: Christian A
authors.initials: CA
authors.lastname: Schmittinger
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.forename: Esko
authors.initials: E
authors.lastname: Ruokonen
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods / Q000592:standards; D003430:Cross-Sectional Studies; D005060:Europe; D005440:Fluid Therapy; D019983:Guideline Adherence; D019538:Health Care Surveys; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011446:Prospective Studies; D012151:Resuscitation; D012772:Shock, Septic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents