Abstract
Background: Sepsis and septic shock are medical emergencies with a high risk of poor prognosis. We investigate the correspondence between Surviving Sepsis Campaign (SSC) guidelines and clinical practice in Poland, with special attention given to differences between ICU and non-ICU environments as well as regional variations within the country. Methods: A web-based questionnaire study was performed on a random sample of 60 hospitals from the three most populated regions in Poland—Masovia, Silesia, and Greater Poland. A 19-item questionnaire was built based on the most recent edition of SSC guidelines. Results: Sepsis diagnosis was primarily based on clinical evaluation (ICUs: 94%, non-ICUs: 62%; p = 0.02). There were significant differences between ICUs and non-ICUs regarding taking blood cultures for pathogen identification (2-times more frequent in ICUs) and having hospital-based operating procedures to adjust antimicrobial treatment to a clinical scenario (a difference of 17%). Modification of empiric antimicrobial treatment was required post-ICU admission in 70% of cases. ICUs differed from non-ICUs with regard to the methods of fluid responsiveness assessment and the types of catecholamines and fluids used to treat septic shock. The mean fluid load applied before the implementation of catecholamines was 25.8 ± 10.6 mL/kg. Norepinephrine was the first-line agent used to treat shock, and balanced crystalloids were preferred in both ICUs and non-ICUs. Conclusion: Compliance with SCC guidelines in Polish hospitals is insufficient, especially outside ICUs. There is a need for education among healthcare professionals to reach at least an acceptable level of knowledge and attitude in this field.
Highlights
Sepsis and septic shock are medical emergencies with a high risk of poor prognosis
care bundles” (CB) usually need to be adjusted to local needs and possibilities and may differ between intensive care units (ICUs) and other hospital wards due to differences in equipment, personnel, and procedures
We are 2021, 9, x FOR PEER REVIEW found statistically significant differences in using clinical evaluation and the implementation of the National Early Warning Score 2 (NEWS2) between ICUs and non-ICUs: clinical evaluation was applied in 94% of ICUs and only in 62% of non-ICUs; infrequent application of NEWS2 was related to lack of rapid response teams (RRTs), which were available only in 17% of hospitals (Figure 2)
Summary
Sepsis and septic shock are medical emergencies with a high risk of poor prognosis. Mortality in septic shock reaches 50% [1] and remains at this level with the passing years [2,3]. As a part of the Surviving Sepsis Campaign (SSC), updated guidelines were published on optimal diagnostic and therapeutic management [5]. These international recommendations describe the so-called “care bundles” (CB), comprising procedures to be performed in case of suspected or confirmed sepsis in the first, third and sixth hours after their identification [5]. There were significant differences between ICUs and non-ICUs regarding taking blood cultures for pathogen identification (2-times more frequent in ICUs) and having hospital-based operating procedures to adjust antimicrobial treatment to a clinical scenario (a difference of 17%). There is a need for education among healthcare professionals to reach at least an acceptable level of knowledge and attitude in this field
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