Recombinant activated protein C usage in Scotland: a comparison with published guidelines and a survey of attitudes.
Severe sepsis is a common cause of admission to the intensive care unit and is associated with a high hospital mortality. This audit explored the current use of, and attitudes towards, recombinant activated protein C therapy across Scotland, and compared these with current guidance. Patients with severe sepsis were followed for three days. Consideration and/or usage of recombinant activated protein C were compared with two different guidelines. Ninety-seven patients were admitted to the intensive care unit over the audit period. Recombinant activated protein C was used in nine of these patients. Depending on the criteria used, between 50% and 81% of the patients who qualified for recombinant activated protein C therapy did not receive it. Subsequent to the audit, a survey was performed to study intensive care unit consultants' attitudes to recombinant activated protein C therapy. A total of 125 consultants responded to the survey (77%). Of these, 104 (83%) stated that they used recombinant activated protein C in their clinical practice, 56 (52%) of whom prescribed it to patients with two-organ failures and an Acute Physiology and Chronic Health Evaluation II score of ≥ 25. Thirty-nine respondents (38%) stated that two-organ failures alone would be an adequate trigger for therapy. We conclude that recombinant activated protein C is potentially under-used to treat severe sepsis. Many consultants seem to reserve the drug for the most severely ill sub group of patients.
 Consultant.
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Puxty
 Consultant, Anaesthesia and Intensive Care Medicine, Crosshouse Hospital, Kilmarnock, Scotland.
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McConnell
 Specialty Registrar, Anaesthesia and Critical Care, Ninewells Hospital, Dundee, Scotland.
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Crawley
 Specialist Registrar, Anaesthesia, Victoria Infirmary, Glasgow, Scotland.
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McAree
 Senior Lecturer and Honorary Consultant, Anaesthesia and Intensive Care Medicine, Glasgow Royal Infirmary, Glasgow, Scotland.
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Quasim
 Consultant, Department of Anaesthesia and Intensive Care Medicine, Western Infirmary, Glasgow, Scotland.
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Ramsay
D018806:APACHE; D001291:Attitude of Health Personnel; D000075202:Contraindications; D003422:Critical Care; D003625:Data Collection; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012606:Scotland / Q000453:epidemiology; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
D011486:Protein C; D011994:Recombinant Proteins