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. 2022 Apr:68:144-154.
doi: 10.1016/j.jcrc.2021.11.016. Epub 2021 Dec 9.

An international survey of adherence to Surviving Sepsis Campaign Guidelines 2016 regarding fluid resuscitation and vasopressors in the initial management of septic shock

Eden Bitton  1 , Shmuel Zimmerman  1 , Luciano Cesar Pontes Azevedo  2 , Dan Benhamou  3 , Maurizio Cecconi  4 , Jan J De Waele  5 , Jeffrey Lipman  6 , Ignacio Martin-Loeches  7 , Romain Pirracchio  8 , Thomas W L Scheeren  9 , Marc Leone  10 , Sharon Einav  1
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An international survey of adherence to Surviving Sepsis Campaign Guidelines 2016 regarding fluid resuscitation and vasopressors in the initial management of septic shock

Eden Bitton et al. J Crit Care. 2022 Apr.

Abstract

Background: Our survey aimed to evaluate adherence to Surviving Sepsis Campaign (SSC) Guidelines 2016 among intensive care practitioners and to identify issues that remain controversial or lack clarity.

Methods: Members of the European Society of Intensive Care Medicine (ESICM) were surveyed using an anonymous web-based survey written by an international group of experts. The primary outcome measure was the rate of adherence to specific recommendations. Secondary outcomes were to describe areas of controversy and lack of data and to associate specific practices with clinician characteristics.

Results: Overall 820 questionnaires were completed. The SCC recommendations 2016 most adhered to were the choice of norepinephrine as first-line vasoactive drug (96.5%), vasopressor prescription based on therapeutic goal rather than dose (83.4%), targeting a specific mean arterial blood pressure during vasopressor use (77.9%), monitoring of blood pressure invasively (62.8%) and adding vasopressin or epinephrine as a second vasoactive agent (83.4%). We identified an internal conflict with regards to parallel versus sequential administration of fluids and vasoactive drugs and regional differences in practice that may be related to drug availabilities.

Conclusion: The use of vasopressors and fluid use in septic shock is largely compliant with current guidelines but several controversies should be addressed in future guideline iterations.

Keywords: Compliance; Dopamine (MeSH); Guidelines; Norepinephrine (MeSH); Sepsis (MeSH); Vasopressor.

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Conflict of interest statement

Declaration of Competing Interest EB. No relevant conflicts of interest. SZ. No relevant conflicts of interest. LCPA received research grants from Ache Laboratorios farmaceuticos, consulting fees from Halex-Istar and lecture fees from Pfizer and Baxter, all outside the present work. DB. No relevant conflicts of interest. MC. No relevant conflicts of interest. JDW received consulting fees from Pfizer and MSD (all outside the present work, and honoraria were paid to his institution). JL. No relevant conflicts of interest. IML received fees from MSD and Aspen for lectures and from Pfizer, Gilead and Ambu for consulting. RP. No relevant conflicts of interest. TWLS received research grants and honoraria from Edwards Lifesciences (Irvine, CA, USA) and Masimo Inc. (Irvine, CA, USA) for consulting and lecturing (all payments made to institution). ML. Received fees from MSD and Aspen for lectures and from Amomed, Gilead and Ambu for consulting. SE. No relevant conflicts of interest.

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