A survey of clinicians addressing the approach to the management of severe sepsis and septic shock in the United States

Purpose Mortality in severe and septic shock (SS/SS) remains high Surviving Sepsis Campagin (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 spectrally Materials and 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 spectrally 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 hepatic and central venous pressure use corticosteriods and droticogen alpha and aim for normoglycemia and plateau pressures less than 30 cm H-O m mechanically ventilated patients (till P < 001) Conclusions We observe that adherence with SSC guidelines continues to be a challenge for CCM IM and EM physicians Stimulant differences in management of SS/SS exist ffor the 8 specialties Because guidelines implementation impacts patient outcomes further evaluation of these differences is warrented. (C) 2010 Elsevier Inc. All rights reserved