Background: Recently, Surviving Sepsis Campaign (SSC) guideline was updated. Our objective was to evaluate the knowledge of residents in different departments regarding the SSC 2012.
Methods: A cross-sectional, descriptive self-questionnaire was distributed to interns and residents in the Departments of Internal Medicine, Surgery, and Emergency Medicine.
Results: The response rate was 136 (89%) from 153 residents. The residents included 46 (33%) interns, 42 (31%) internal medicine residents, 41 (30%) surgical residents, and 7 (5%) emergency residents. Regarding the definitions of severe sepsis and septic shock, only 44 (32.4%) residents were able to differentiate the severity of sepsis. The surgical residents had a significantly lower rate of correct answers than that of internal medicine residents (12.2% vs. 45.2, P= 0.001), emergency residents (12.2% vs. 57.1%, P = 0.005), and interns (12.2% vs. 34.8%, P = 0.014). Only 77 (51.5%) residents would measure blood lactate in patients with sepsis. In respect to the dose of fluid resuscitation, only 72 (52.9%) residents gave the recommended fluid (30 ml/kg) within the first 3 h. Surgical residents had a significantly lesser percentage of correct answers than that of internal medicine residents (29.3% vs. 69%, P < 0.0001) and interns (29.3% vs. 60.8%, P = 0.003). About 123 (90.4%) and 115 (84.6%) residents knew the appropriate targets for mean arterial pressure and vasopressors, respectively. Most residents could give antimicrobial drugs (73.5%) and steroids (93.4%) appropriately in the treatment of patients with septic shock. However, only half of the residents knew the target range of blood sugar control in patients with sepsis.
Conclusions: Our residents' knowledge about the SSC 2012 is not satisfactory. Further instruction concerning sepsis management is required.
Khwannimit B, Bhurayanontachai R. The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiol Infect 2009;137:1333-41.
Shen HN, Lu CL, Yang HH. Epidemiologic trend of severe sepsis in Taiwan from 1997 through 2006. Chest 2010;138:298-304.
Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014;311:1308-16.
Beale R, Reinhart K, Brunkhorst FM, Dobb G, Levy M, Martin G, et al. Promoting Global Research Excellence in Severe Sepsis (PROGRESS): Lessons from an international sepsis registry. Infection 2009;37:222-32.
Fujishima S, Gando S, Saitoh D, Mayumi T, Kushimoto S, Shiraishi S, et al. A multicenter, prospective evaluation of quality of care and mortality in Japan based on the Surviving Sepsis Campaign guidelines. J Infect Chemother 2014;20:115-20.
Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X, et al. Epidemiology and outcome of severe sepsis and septic shock in Intensive Care Units in mainland China. PLoS One 2014;9:e107181.
Quenot JP, Binquet C, Kara F, Martinet O, Ganster F, Navellou JC, et al. The epidemiology of septic shock in French Intensive Care Units: The prospective multicenter cohort EPISS study. Crit Care 2013;17:R65.
Khwannimit B, Bhurayanontachai R. The direct costs of intensive care management and risk factors for financial burden of patients with severe sepsis and septic shock. J Crit Care 2015;30:929-34.
Sogayar AM, Machado FR, Rea-Neto A, Dornas A, Grion CM, Lobo SM, et al. A multicentre, prospective study to evaluate costs of septic patients in Brazilian Intensive Care Units. Pharmacoeconomics 2008;26:425-34.
Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 2004;30:536-55.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165-228.
Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, et al. Surviving Sepsis Campaign: Association between performance metrics and outcomes in a 7.5-year study. Intensive Care Med 2014;40:1623-33.
Rhodes A, Phillips G, Beale R, Cecconi M, Chiche JD, De Backer D, et al. The Surviving Sepsis Campaign bundles and outcome: Results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Med 2015;41:1620-8.
Na S, Kuan WS, Mahadevan M, Li CH, Shrikhande P, Ray S, et al. Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia. Int J Qual Health Care 2012;24:452-62.
Ferrer R, Artigas A, Levy MM, Blanco J, González-Díaz G, Garnacho-Montero J, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 2008;299:2294-303.
Phua J, Koh Y, Du B, Tang YQ, Divatia JV, Tan CC, et al. Management of severe sepsis in patients admitted to Asian Intensive Care Units: Prospective cohort study. BMJ 2011;342:d3245.
Reade MC, Huang DT, Bell D, Coats TJ, Cross AM, Moran JL, et al. Variability in management of early severe sepsis. Emerg Med J 2010;27:110-5.
Fernández R, Galera A, Rodriguez W, Mora ER, Rodríguez-Vega G. Sepsis: A study of physician's knowledge about the surviving sepsis campaign in Puerto Rico. Crit Care Shock 2007;10:131-41.
Assunção M, Akamine N, Cardoso GS, Mello PV, Teles JM, Nunes AL, et al. Survey on physicians' knowledge of sepsis: Do they recognize it promptly? J Crit Care 2010;25:545-52.
Tufan ZK, Eser FC, Vudali E, Batirel A, Kayaaslan B, Bastug AT, et al. The knowledge of the physicians about sepsis bundles is suboptimal: A multicenter survey. J Clin Diagn Res 2015;9:OC13-6.
Ziglam HM, Morales D, Webb K, Nathwani D. Knowledge about sepsis among training-grade doctors. J Antimicrob Chemother 2006;57:963-5.
Puskarich MA, Trzeciak S, Shapiro NI, Heffner AC, Kline JA, Jones AE; Emergency Medicine Shock Research Network (EMSHOCKNET). Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock. Resuscitation 2011;82:1289-93.
Li CH, Kuan WS, Mahadevan M, Daniel-Underwood L, Chiu TF, Nguyen HB; ATLAS Investigators (Asia neTwork to reguLAte Sepsis care). A multinational randomised study comparing didactic lectures with case scenario in a severe sepsis medical simulation course. Emerg Med J 2012;29:559-64.
Evans KH, Daines W, Tsui J, Strehlow M, Maggio P, Shieh L. Septris: A novel, mobile, online, simulation game that improves sepsis recognition and management. Acad Med 2015;90:180-4.
Cecconi M, Aya HD. Central venous pressure cannot predict fluid-responsiveness. Evid Based Med 2014;19:63.
Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med 2013;41:1774-81.
Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014;40:1795-815.
Cecconi M, Hofer C, Teboul JL, Pettila V, Wilkman E, Molnar Z, et al. Fluid challenges in intensive care: The FENICE study: A global inception cohort study. Intensive Care Med 2015;41:1529-37.
McIntyre LA, Hébert PC, Fergusson D, Cook DJ, Aziz A; Canadian Critical Care Trials Group. A survey of Canadian intensivists' resuscitation practices in early septic shock. Crit Care 2007;11:R74.