Abstract
We aimed to describe anesthesiologists' knowledge of and compliance with the Surviving Sepsis Campaign (SSC) guidelines in the perioperative management of patients with sepsis in China. We designed a questionnaire-based, cross-sectional survey. We sent out online questionnaires during 2019 to evaluate whether anesthesiologists in China were familiar with and applied SSC guidelines in perioperative management. We also compared anesthesiologists' knowledge of and compliance with the guidelines among different levels of hospital. In this study, we obtained 971 responses from anesthesiology departments across China. The survey responses showed that 39.0% of anesthesiologists rated their knowledge of the SSC guidelines as being “very familiar” or at least “somewhat familiar.” In total, 68.9% of respondents chose “Initial fluid resuscitation followed by frequent hemodynamic reassessment” as their therapy strategy for patients with septic shock; 62.0% of anesthesiologists chose lactate as a marker of initial resuscitation in clinical practice, and 39.1% thought bundle therapy needed to be started within 1 hour of sepsis diagnosis. A total of 37.1% and 27.1% of respondents chose hydroxyethyl starches and gelatins, respectively, as the preferred fluids for septic shock. As the first choice of vasopressors in patients with sepsis, 727 (74.9%) anesthesiologists chose the correct answer (norepinephrine). Anesthesiologists from tertiary hospitals (class A) had greater familiarity and compliance with the SSC guidelines than those from other hospitals (P < 0.001). In summary, anesthesiologists in China have some knowledge of the SSC guidelines and tend to practice in keeping with these guidelines. However, for some items, anesthesiologists are not up to date with the latest version of the SSC guidelines. The popularity of these guidelines is not homogenous among different levels of hospital. Anesthesiologists must strengthen their knowledge of the SSC guidelines and update their practice in a regular and timely manner, especially in other tertiary and primary hospitals.
Highlights
As one of the most challenging medical problems, sepsis is defined as life-threatening organ dysfunction induced by an uncontrolled host response to infection [1, 2]
We mainly focused on fluid administration and the use of vasoactive drugs for patients with sepsis. e questionnaires comprised three main aspects: (1) demographic information, including age, regional distribution, degree and title, years of working as an anesthesiologist, and hospital level; (2) anesthesiologists’ overall familiarity with the Sepsis Campaign (SSC) guidelines and how well they had mastered the guidelines; and (3) anesthesiologists’ compliance with and application of the guidelines in their clinical practice
To explore the differences among levels of hospital, we divided hospitals where anesthesiologists worked into four groups: university-affiliated tertiary hospitals, nonaffiliated tertiary hospitals, other tertiary hospitals, and primary hospitals. ere were 462 (47.6%), 193 (19.9%), 111 (11.4%), and 205 (21.1%) survey respondents from university-affiliated tertiary hospitals, nonaffiliated tertiary hospitals, other tertiary hospitals, and primary hospitals, respectively
Summary
As one of the most challenging medical problems, sepsis is defined as life-threatening organ dysfunction induced by an uncontrolled host response to infection [1, 2]. In the SSC, four editions of clinical guidelines were formulated on the basis of existing clinical evidence, in 2004, 2008, 2012, and 2016, aiming to guide clinicians in diagnosing and treating patients with sepsis. Increasing evidence has indicated that implementation of the SSC guidelines is associated with improved outcomes in both adults and children with sepsis [5,6,7,8]. Sepsis is an important cause of death in critically ill surgical patients. A study in the United States showed that the incidence of sepsis in patients undergoing surgery is 20.2% [9]. Our team conducted a multicenter, nationwide, epidemiological survey of surgical patients with sepsis in China, the results of which showed that the overall
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