Cargando…
A survey of Canadian intensivists' resuscitation practices in early septic shock
INTRODUCTION: Recent evidence suggests that early, aggressive resuscitation in patients with septic shock reduces mortality. The objective of this survey was to characterize reported resuscitation practices of Canadian physicians caring for adult critically ill patients with early septic shock. METH...
Autores principales: | , , , , |
---|---|
Formato: | Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2007
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206518/ https://www.ncbi.nlm.nih.gov/pubmed/17623059 http://dx.doi.org/10.1186/cc5962 |
_version_ | 1782148490915217408 |
---|---|
author | McIntyre, Lauralyn A Hébert, Paul C Fergusson, Dean Cook, Deborah J Aziz, Ashique |
author_facet | McIntyre, Lauralyn A Hébert, Paul C Fergusson, Dean Cook, Deborah J Aziz, Ashique |
author_sort | McIntyre, Lauralyn A |
collection | PubMed |
description | INTRODUCTION: Recent evidence suggests that early, aggressive resuscitation in patients with septic shock reduces mortality. The objective of this survey was to characterize reported resuscitation practices of Canadian physicians caring for adult critically ill patients with early septic shock. METHODS: A scenario-based self-administered national survey was sent out to Canadian critical care physicians. One hypothetical scenario was developed to obtain information on several aspects of resuscitation in early septic shock, including monitoring and resuscitation end-points, fluid administration, red blood cell transfusion triggers, and use of inotropes. The sampling frame was physician members of Canadian national and provincial critical care societies. RESULTS: The survey response rate was 232 out of 355 (65.3%). Medicine was the most common primary specialty (60.0%), most respondents had practiced for 6 to 10 years (30.0%), and 82.0% were male. The following monitoring devices/parameters were reported as used/measured 'often' or 'always' by at least 89% of respondents: oxygen saturation (100%), Foley catheters (100%), arterial blood pressure lines (96.6%), telemetry (94.3%), and central venous pressure (89.2%). Continuous monitoring of central venous oxygen saturation was employed 'often' or 'always' by 9.8% of respondents. The two most commonly cited resuscitation end-points were urine output (96.5%) and blood pressure (91.8%). Over half of respondents used normal saline (84.5%), Ringers lactate (52.2%), and pentastarch (51.3%) 'often' or 'always' for early fluid resuscitation. In contrast, 5% and 25% albumin solutions were cited as used 'often' or 'always' by 3.9% and 1.3% of respondents, respectively. Compared with internists, surgeons and anesthesiologists (odds ratio (95% confidence interval): 9.8 (2.9 to 32.7) and 3.8 (1.7 to 8.7), respectively) reported greater use of Ringers lactate. In the setting of a low central venous oxygen saturation, 52.5% of respondents reported use of inotropic support 'often' or 'always'. Only 7.6% of physicians stated they would use a red blood cell transfusion trigger of 100 g/l to optimize oxygen delivery further. CONCLUSION: Our survey results suggest that there is substantial practice variation in the resuscitation of adult patients with early septic shock. More randomized trials are needed to determine the optimal approach. |
format | Text |
id | pubmed-2206518 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2007 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-22065182008-01-19 A survey of Canadian intensivists' resuscitation practices in early septic shock McIntyre, Lauralyn A Hébert, Paul C Fergusson, Dean Cook, Deborah J Aziz, Ashique Crit Care Research INTRODUCTION: Recent evidence suggests that early, aggressive resuscitation in patients with septic shock reduces mortality. The objective of this survey was to characterize reported resuscitation practices of Canadian physicians caring for adult critically ill patients with early septic shock. METHODS: A scenario-based self-administered national survey was sent out to Canadian critical care physicians. One hypothetical scenario was developed to obtain information on several aspects of resuscitation in early septic shock, including monitoring and resuscitation end-points, fluid administration, red blood cell transfusion triggers, and use of inotropes. The sampling frame was physician members of Canadian national and provincial critical care societies. RESULTS: The survey response rate was 232 out of 355 (65.3%). Medicine was the most common primary specialty (60.0%), most respondents had practiced for 6 to 10 years (30.0%), and 82.0% were male. The following monitoring devices/parameters were reported as used/measured 'often' or 'always' by at least 89% of respondents: oxygen saturation (100%), Foley catheters (100%), arterial blood pressure lines (96.6%), telemetry (94.3%), and central venous pressure (89.2%). Continuous monitoring of central venous oxygen saturation was employed 'often' or 'always' by 9.8% of respondents. The two most commonly cited resuscitation end-points were urine output (96.5%) and blood pressure (91.8%). Over half of respondents used normal saline (84.5%), Ringers lactate (52.2%), and pentastarch (51.3%) 'often' or 'always' for early fluid resuscitation. In contrast, 5% and 25% albumin solutions were cited as used 'often' or 'always' by 3.9% and 1.3% of respondents, respectively. Compared with internists, surgeons and anesthesiologists (odds ratio (95% confidence interval): 9.8 (2.9 to 32.7) and 3.8 (1.7 to 8.7), respectively) reported greater use of Ringers lactate. In the setting of a low central venous oxygen saturation, 52.5% of respondents reported use of inotropic support 'often' or 'always'. Only 7.6% of physicians stated they would use a red blood cell transfusion trigger of 100 g/l to optimize oxygen delivery further. CONCLUSION: Our survey results suggest that there is substantial practice variation in the resuscitation of adult patients with early septic shock. More randomized trials are needed to determine the optimal approach. BioMed Central 2007 2007-07-10 /pmc/articles/PMC2206518/ /pubmed/17623059 http://dx.doi.org/10.1186/cc5962 Text en Copyright © 2007 McIntyre et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research McIntyre, Lauralyn A Hébert, Paul C Fergusson, Dean Cook, Deborah J Aziz, Ashique A survey of Canadian intensivists' resuscitation practices in early septic shock |
title | A survey of Canadian intensivists' resuscitation practices in early septic shock |
title_full | A survey of Canadian intensivists' resuscitation practices in early septic shock |
title_fullStr | A survey of Canadian intensivists' resuscitation practices in early septic shock |
title_full_unstemmed | A survey of Canadian intensivists' resuscitation practices in early septic shock |
title_short | A survey of Canadian intensivists' resuscitation practices in early septic shock |
title_sort | survey of canadian intensivists' resuscitation practices in early septic shock |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206518/ https://www.ncbi.nlm.nih.gov/pubmed/17623059 http://dx.doi.org/10.1186/cc5962 |
work_keys_str_mv | AT mcintyrelauralyna asurveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT hebertpaulc asurveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT fergussondean asurveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT cookdeborahj asurveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT azizashique asurveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT asurveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT mcintyrelauralyna surveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT hebertpaulc surveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT fergussondean surveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT cookdeborahj surveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT azizashique surveyofcanadianintensivistsresuscitationpracticesinearlysepticshock AT surveyofcanadianintensivistsresuscitationpracticesinearlysepticshock |