Practice and perception—A nationwide survey of therapy habits in sepsis
OBJECTIVE:To simultaneously determine perceived vs. practiced adherence to recommended interventions for the treatment of severe sepsis or septic shock. DESIGN:One-day cross-sectional survey. SETTING:Representative sample of German intensive care units stratified by hospital size. PATIENTS:Adult pat...
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| Veröffentlicht in: | Critical care medicine 2008-10, Vol.36 (10), p.2719-2725 |
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| creator | Brunkhorst, Frank M Engel, Christoph Ragaller, Max Welte, Tobias Rossaint, Rolf Gerlach, Herwig Mayer, Konstantin John, Stefan Stuber, Frank Weiler, Norbert Oppert, Michael Moerer, Onnen Bogatsch, Holger Reinhart, Konrad Loeffler, Markus Hartog, Christiane |
| description | OBJECTIVE:To simultaneously determine perceived vs. practiced adherence to recommended interventions for the treatment of severe sepsis or septic shock.
DESIGN:One-day cross-sectional survey.
SETTING:Representative sample of German intensive care units stratified by hospital size.
PATIENTS:Adult patients with severe sepsis or septic shock.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Practice recommendations were selected by German Sepsis Competence Network (SepNet) investigators. External intensivists visited intensive care units randomly chosen and asked the responsible intensive care unit director how often these recommendations were used. Responses “always” and “frequently” were combined to depict perceived adherence. Thereafter patient files were audited. Three hundred sixty-six patients on 214 intensive care units fulfilled the criteria and received full support. One hundred fifty-two patients had acute lung injury or acute respiratory distress syndrome. Low-tidal volume ventilation ≤6 mL/kg/predicted body weight was documented in 2.6% of these patients. A total of 17.1% patients had tidal volume between 6 and 8 mL/kg predicted body weight and 80.3% >8 mL/kg predicted body weight. Mean tidal volume was 10.0 ± 2.4 mL/kg predicted body weight. Perceived adherence to low-tidal volume ventilation was 79.9%. Euglycemia (4.4–6.1 mmol/L) was documented in 6.2% of 355 patients. A total of 33.8% of patients had blood glucose levels ≤8.3 mmol/L and 66.2% were hyperglycemic (blood glucose >8.3 mmol/L). Among 207 patients receiving insulin therapy, 1.9% were euglycemic, 20.8% had blood glucose levels ≤8.3 mmol/L, and 1.0% were hypoglycemic. Overall, mean maximal glucose level was 10.0 ± 3.6 mmol/L. Perceived adherence to strict glycemic control was 65.9%. Although perceived adherence to recommendations was higher in academic and larger hospitals, actual practice was not significantly influenced by hospital size or university affiliation.
CONCLUSIONS:This representative survey shows that current therapy of severe sepsis in German intensive care units complies poorly with practice recommendations. Intensive care unit directors perceive adherence to be higher than it actually is. Implementation strategies involving all intensive care unit staff are needed to overcome this gap between current evidence-based knowledge, practice, and perception. |
| doi_str_mv | 10.1097/CCM.0b013e318186b6f3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69602548</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69602548</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3801-5c564169982687d1a170345749278bab874e2a49e385f6c131616a808cac6e6b3</originalsourceid><addsrcrecordid>eNpdkM1u1DAQxy1ERZfCGyDkC72lzMSOYx-rFZRKRfQAZ2vinWgN2STYSVd74yF4Qp6ErLqiEnOYD-k3X38h3iBcIbj6_Xr9-QoaQMUKLVrTmFY9EyusFBRQOvVcrAAcFEo7dS5e5vwdAHVVqxfiHG1tDAKsxO19ojDFwJL6jRw5BR6nOPR_fv2-lj0d033csMxzeuCDHFo5bTnReJBbauKUZexl5jHH_EqctdRlfn2KF-Lbxw9f15-Kuy83t-vruyIoC1hUoTIajXO2NLbeIGENajlLu7K2DTW21lySdqxs1ZqACg0asmADBcOmURfi8nHumIafM-fJ72IO3HXU8zBnb5yBstJ2AfUjGNKQc-LWjynuKB08gj9K6BcJ_f8SLm1vT_PnZsebp6aTZgvw7gRQDtS1ifoQ8z-uhBqXZ9TT_v3QTZzyj27ec_Jbpm7aelhMldoUJYDFY1UcHaq_fkCJaQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69602548</pqid></control><display><type>article</type><title>Practice and perception—A nationwide survey of therapy habits in sepsis</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Brunkhorst, Frank M ; Engel, Christoph ; Ragaller, Max ; Welte, Tobias ; Rossaint, Rolf ; Gerlach, Herwig ; Mayer, Konstantin ; John, Stefan ; Stuber, Frank ; Weiler, Norbert ; Oppert, Michael ; Moerer, Onnen ; Bogatsch, Holger ; Reinhart, Konrad ; Loeffler, Markus ; Hartog, Christiane</creator><creatorcontrib>Brunkhorst, Frank M ; Engel, Christoph ; Ragaller, Max ; Welte, Tobias ; Rossaint, Rolf ; Gerlach, Herwig ; Mayer, Konstantin ; John, Stefan ; Stuber, Frank ; Weiler, Norbert ; Oppert, Michael ; Moerer, Onnen ; Bogatsch, Holger ; Reinhart, Konrad ; Loeffler, Markus ; Hartog, Christiane ; German Sepsis Competence Network (SepNet)</creatorcontrib><description>OBJECTIVE:To simultaneously determine perceived vs. practiced adherence to recommended interventions for the treatment of severe sepsis or septic shock.
DESIGN:One-day cross-sectional survey.
SETTING:Representative sample of German intensive care units stratified by hospital size.
PATIENTS:Adult patients with severe sepsis or septic shock.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Practice recommendations were selected by German Sepsis Competence Network (SepNet) investigators. External intensivists visited intensive care units randomly chosen and asked the responsible intensive care unit director how often these recommendations were used. Responses “always” and “frequently” were combined to depict perceived adherence. Thereafter patient files were audited. Three hundred sixty-six patients on 214 intensive care units fulfilled the criteria and received full support. One hundred fifty-two patients had acute lung injury or acute respiratory distress syndrome. Low-tidal volume ventilation ≤6 mL/kg/predicted body weight was documented in 2.6% of these patients. A total of 17.1% patients had tidal volume between 6 and 8 mL/kg predicted body weight and 80.3% >8 mL/kg predicted body weight. Mean tidal volume was 10.0 ± 2.4 mL/kg predicted body weight. Perceived adherence to low-tidal volume ventilation was 79.9%. Euglycemia (4.4–6.1 mmol/L) was documented in 6.2% of 355 patients. A total of 33.8% of patients had blood glucose levels ≤8.3 mmol/L and 66.2% were hyperglycemic (blood glucose >8.3 mmol/L). Among 207 patients receiving insulin therapy, 1.9% were euglycemic, 20.8% had blood glucose levels ≤8.3 mmol/L, and 1.0% were hypoglycemic. Overall, mean maximal glucose level was 10.0 ± 3.6 mmol/L. Perceived adherence to strict glycemic control was 65.9%. Although perceived adherence to recommendations was higher in academic and larger hospitals, actual practice was not significantly influenced by hospital size or university affiliation.
CONCLUSIONS:This representative survey shows that current therapy of severe sepsis in German intensive care units complies poorly with practice recommendations. Intensive care unit directors perceive adherence to be higher than it actually is. Implementation strategies involving all intensive care unit staff are needed to overcome this gap between current evidence-based knowledge, practice, and perception.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e318186b6f3</identifier><identifier>PMID: 18766100</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; APACHE ; Attitude of Health Personnel ; Biological and medical sciences ; Blood Glucose - analysis ; Combined Modality Therapy ; Critical Care - standards ; Critical Care - trends ; Critical Illness - mortality ; Critical Illness - therapy ; Cross-Sectional Studies ; Emergency and intensive care: infection, septic shock ; Female ; Germany ; Guideline Adherence ; Hospital Mortality - trends ; Humans ; Intensive care medicine ; Intensive Care Units ; Male ; Medical sciences ; Middle Aged ; Needs Assessment ; Practice Guidelines as Topic ; Probability ; Quality of Health Care ; Respiratory Distress Syndrome, Adult - diagnosis ; Respiratory Distress Syndrome, Adult - therapy ; Sepsis - diagnosis ; Sepsis - mortality ; Sepsis - therapy ; Shock, Septic - diagnosis ; Shock, Septic - mortality ; Shock, Septic - therapy ; Survival Analysis ; Tidal Volume - physiology ; Treatment Outcome</subject><ispartof>Critical care medicine, 2008-10, Vol.36 (10), p.2719-2725</ispartof><rights>2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3801-5c564169982687d1a170345749278bab874e2a49e385f6c131616a808cac6e6b3</citedby><cites>FETCH-LOGICAL-c3801-5c564169982687d1a170345749278bab874e2a49e385f6c131616a808cac6e6b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20714923$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18766100$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brunkhorst, Frank M</creatorcontrib><creatorcontrib>Engel, Christoph</creatorcontrib><creatorcontrib>Ragaller, Max</creatorcontrib><creatorcontrib>Welte, Tobias</creatorcontrib><creatorcontrib>Rossaint, Rolf</creatorcontrib><creatorcontrib>Gerlach, Herwig</creatorcontrib><creatorcontrib>Mayer, Konstantin</creatorcontrib><creatorcontrib>John, Stefan</creatorcontrib><creatorcontrib>Stuber, Frank</creatorcontrib><creatorcontrib>Weiler, Norbert</creatorcontrib><creatorcontrib>Oppert, Michael</creatorcontrib><creatorcontrib>Moerer, Onnen</creatorcontrib><creatorcontrib>Bogatsch, Holger</creatorcontrib><creatorcontrib>Reinhart, Konrad</creatorcontrib><creatorcontrib>Loeffler, Markus</creatorcontrib><creatorcontrib>Hartog, Christiane</creatorcontrib><creatorcontrib>German Sepsis Competence Network (SepNet)</creatorcontrib><title>Practice and perception—A nationwide survey of therapy habits in sepsis</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:To simultaneously determine perceived vs. practiced adherence to recommended interventions for the treatment of severe sepsis or septic shock.
DESIGN:One-day cross-sectional survey.
SETTING:Representative sample of German intensive care units stratified by hospital size.
PATIENTS:Adult patients with severe sepsis or septic shock.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Practice recommendations were selected by German Sepsis Competence Network (SepNet) investigators. External intensivists visited intensive care units randomly chosen and asked the responsible intensive care unit director how often these recommendations were used. Responses “always” and “frequently” were combined to depict perceived adherence. Thereafter patient files were audited. Three hundred sixty-six patients on 214 intensive care units fulfilled the criteria and received full support. One hundred fifty-two patients had acute lung injury or acute respiratory distress syndrome. Low-tidal volume ventilation ≤6 mL/kg/predicted body weight was documented in 2.6% of these patients. A total of 17.1% patients had tidal volume between 6 and 8 mL/kg predicted body weight and 80.3% >8 mL/kg predicted body weight. Mean tidal volume was 10.0 ± 2.4 mL/kg predicted body weight. Perceived adherence to low-tidal volume ventilation was 79.9%. Euglycemia (4.4–6.1 mmol/L) was documented in 6.2% of 355 patients. A total of 33.8% of patients had blood glucose levels ≤8.3 mmol/L and 66.2% were hyperglycemic (blood glucose >8.3 mmol/L). Among 207 patients receiving insulin therapy, 1.9% were euglycemic, 20.8% had blood glucose levels ≤8.3 mmol/L, and 1.0% were hypoglycemic. Overall, mean maximal glucose level was 10.0 ± 3.6 mmol/L. Perceived adherence to strict glycemic control was 65.9%. Although perceived adherence to recommendations was higher in academic and larger hospitals, actual practice was not significantly influenced by hospital size or university affiliation.
CONCLUSIONS:This representative survey shows that current therapy of severe sepsis in German intensive care units complies poorly with practice recommendations. Intensive care unit directors perceive adherence to be higher than it actually is. Implementation strategies involving all intensive care unit staff are needed to overcome this gap between current evidence-based knowledge, practice, and perception.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>APACHE</subject><subject>Attitude of Health Personnel</subject><subject>Biological and medical sciences</subject><subject>Blood Glucose - analysis</subject><subject>Combined Modality Therapy</subject><subject>Critical Care - standards</subject><subject>Critical Care - trends</subject><subject>Critical Illness - mortality</subject><subject>Critical Illness - therapy</subject><subject>Cross-Sectional Studies</subject><subject>Emergency and intensive care: infection, septic shock</subject><subject>Female</subject><subject>Germany</subject><subject>Guideline Adherence</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Needs Assessment</subject><subject>Practice Guidelines as Topic</subject><subject>Probability</subject><subject>Quality of Health Care</subject><subject>Respiratory Distress Syndrome, Adult - diagnosis</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Sepsis - diagnosis</subject><subject>Sepsis - mortality</subject><subject>Sepsis - therapy</subject><subject>Shock, Septic - diagnosis</subject><subject>Shock, Septic - mortality</subject><subject>Shock, Septic - therapy</subject><subject>Survival Analysis</subject><subject>Tidal Volume - physiology</subject><subject>Treatment Outcome</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkM1u1DAQxy1ERZfCGyDkC72lzMSOYx-rFZRKRfQAZ2vinWgN2STYSVd74yF4Qp6ErLqiEnOYD-k3X38h3iBcIbj6_Xr9-QoaQMUKLVrTmFY9EyusFBRQOvVcrAAcFEo7dS5e5vwdAHVVqxfiHG1tDAKsxO19ojDFwJL6jRw5BR6nOPR_fv2-lj0d033csMxzeuCDHFo5bTnReJBbauKUZexl5jHH_EqctdRlfn2KF-Lbxw9f15-Kuy83t-vruyIoC1hUoTIajXO2NLbeIGENajlLu7K2DTW21lySdqxs1ZqACg0asmADBcOmURfi8nHumIafM-fJ72IO3HXU8zBnb5yBstJ2AfUjGNKQc-LWjynuKB08gj9K6BcJ_f8SLm1vT_PnZsebp6aTZgvw7gRQDtS1ifoQ8z-uhBqXZ9TT_v3QTZzyj27ec_Jbpm7aelhMldoUJYDFY1UcHaq_fkCJaQ</recordid><startdate>200810</startdate><enddate>200810</enddate><creator>Brunkhorst, Frank M</creator><creator>Engel, Christoph</creator><creator>Ragaller, Max</creator><creator>Welte, Tobias</creator><creator>Rossaint, Rolf</creator><creator>Gerlach, Herwig</creator><creator>Mayer, Konstantin</creator><creator>John, Stefan</creator><creator>Stuber, Frank</creator><creator>Weiler, Norbert</creator><creator>Oppert, Michael</creator><creator>Moerer, Onnen</creator><creator>Bogatsch, Holger</creator><creator>Reinhart, Konrad</creator><creator>Loeffler, Markus</creator><creator>Hartog, Christiane</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200810</creationdate><title>Practice and perception—A nationwide survey of therapy habits in sepsis</title><author>Brunkhorst, Frank M ; Engel, Christoph ; Ragaller, Max ; Welte, Tobias ; Rossaint, Rolf ; Gerlach, Herwig ; Mayer, Konstantin ; John, Stefan ; Stuber, Frank ; Weiler, Norbert ; Oppert, Michael ; Moerer, Onnen ; Bogatsch, Holger ; Reinhart, Konrad ; Loeffler, Markus ; Hartog, Christiane</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3801-5c564169982687d1a170345749278bab874e2a49e385f6c131616a808cac6e6b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>APACHE</topic><topic>Attitude of Health Personnel</topic><topic>Biological and medical sciences</topic><topic>Blood Glucose - analysis</topic><topic>Combined Modality Therapy</topic><topic>Critical Care - standards</topic><topic>Critical Care - trends</topic><topic>Critical Illness - mortality</topic><topic>Critical Illness - therapy</topic><topic>Cross-Sectional Studies</topic><topic>Emergency and intensive care: infection, septic shock</topic><topic>Female</topic><topic>Germany</topic><topic>Guideline Adherence</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Needs Assessment</topic><topic>Practice Guidelines as Topic</topic><topic>Probability</topic><topic>Quality of Health Care</topic><topic>Respiratory Distress Syndrome, Adult - diagnosis</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Sepsis - diagnosis</topic><topic>Sepsis - mortality</topic><topic>Sepsis - therapy</topic><topic>Shock, Septic - diagnosis</topic><topic>Shock, Septic - mortality</topic><topic>Shock, Septic - therapy</topic><topic>Survival Analysis</topic><topic>Tidal Volume - physiology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brunkhorst, Frank M</creatorcontrib><creatorcontrib>Engel, Christoph</creatorcontrib><creatorcontrib>Ragaller, Max</creatorcontrib><creatorcontrib>Welte, Tobias</creatorcontrib><creatorcontrib>Rossaint, Rolf</creatorcontrib><creatorcontrib>Gerlach, Herwig</creatorcontrib><creatorcontrib>Mayer, Konstantin</creatorcontrib><creatorcontrib>John, Stefan</creatorcontrib><creatorcontrib>Stuber, Frank</creatorcontrib><creatorcontrib>Weiler, Norbert</creatorcontrib><creatorcontrib>Oppert, Michael</creatorcontrib><creatorcontrib>Moerer, Onnen</creatorcontrib><creatorcontrib>Bogatsch, Holger</creatorcontrib><creatorcontrib>Reinhart, Konrad</creatorcontrib><creatorcontrib>Loeffler, Markus</creatorcontrib><creatorcontrib>Hartog, Christiane</creatorcontrib><creatorcontrib>German Sepsis Competence Network (SepNet)</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brunkhorst, Frank M</au><au>Engel, Christoph</au><au>Ragaller, Max</au><au>Welte, Tobias</au><au>Rossaint, Rolf</au><au>Gerlach, Herwig</au><au>Mayer, Konstantin</au><au>John, Stefan</au><au>Stuber, Frank</au><au>Weiler, Norbert</au><au>Oppert, Michael</au><au>Moerer, Onnen</au><au>Bogatsch, Holger</au><au>Reinhart, Konrad</au><au>Loeffler, Markus</au><au>Hartog, Christiane</au><aucorp>German Sepsis Competence Network (SepNet)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Practice and perception—A nationwide survey of therapy habits in sepsis</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2008-10</date><risdate>2008</risdate><volume>36</volume><issue>10</issue><spage>2719</spage><epage>2725</epage><pages>2719-2725</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:To simultaneously determine perceived vs. practiced adherence to recommended interventions for the treatment of severe sepsis or septic shock.
DESIGN:One-day cross-sectional survey.
SETTING:Representative sample of German intensive care units stratified by hospital size.
PATIENTS:Adult patients with severe sepsis or septic shock.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Practice recommendations were selected by German Sepsis Competence Network (SepNet) investigators. External intensivists visited intensive care units randomly chosen and asked the responsible intensive care unit director how often these recommendations were used. Responses “always” and “frequently” were combined to depict perceived adherence. Thereafter patient files were audited. Three hundred sixty-six patients on 214 intensive care units fulfilled the criteria and received full support. One hundred fifty-two patients had acute lung injury or acute respiratory distress syndrome. Low-tidal volume ventilation ≤6 mL/kg/predicted body weight was documented in 2.6% of these patients. A total of 17.1% patients had tidal volume between 6 and 8 mL/kg predicted body weight and 80.3% >8 mL/kg predicted body weight. Mean tidal volume was 10.0 ± 2.4 mL/kg predicted body weight. Perceived adherence to low-tidal volume ventilation was 79.9%. Euglycemia (4.4–6.1 mmol/L) was documented in 6.2% of 355 patients. A total of 33.8% of patients had blood glucose levels ≤8.3 mmol/L and 66.2% were hyperglycemic (blood glucose >8.3 mmol/L). Among 207 patients receiving insulin therapy, 1.9% were euglycemic, 20.8% had blood glucose levels ≤8.3 mmol/L, and 1.0% were hypoglycemic. Overall, mean maximal glucose level was 10.0 ± 3.6 mmol/L. Perceived adherence to strict glycemic control was 65.9%. Although perceived adherence to recommendations was higher in academic and larger hospitals, actual practice was not significantly influenced by hospital size or university affiliation.
CONCLUSIONS:This representative survey shows that current therapy of severe sepsis in German intensive care units complies poorly with practice recommendations. Intensive care unit directors perceive adherence to be higher than it actually is. Implementation strategies involving all intensive care unit staff are needed to overcome this gap between current evidence-based knowledge, practice, and perception.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>18766100</pmid><doi>10.1097/CCM.0b013e318186b6f3</doi><tpages>7</tpages></addata></record> |
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| ispartof | Critical care medicine, 2008-10, Vol.36 (10), p.2719-2725 |
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| language | eng |
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| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy APACHE Attitude of Health Personnel Biological and medical sciences Blood Glucose - analysis Combined Modality Therapy Critical Care - standards Critical Care - trends Critical Illness - mortality Critical Illness - therapy Cross-Sectional Studies Emergency and intensive care: infection, septic shock Female Germany Guideline Adherence Hospital Mortality - trends Humans Intensive care medicine Intensive Care Units Male Medical sciences Middle Aged Needs Assessment Practice Guidelines as Topic Probability Quality of Health Care Respiratory Distress Syndrome, Adult - diagnosis Respiratory Distress Syndrome, Adult - therapy Sepsis - diagnosis Sepsis - mortality Sepsis - therapy Shock, Septic - diagnosis Shock, Septic - mortality Shock, Septic - therapy Survival Analysis Tidal Volume - physiology Treatment Outcome |
| title | Practice and perception—A nationwide survey of therapy habits in sepsis |
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