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01-06-2003 | Commentary

Variation in sepsis care: a wake-up call

Authors: Mary E Hartman, Derek C Angus

Published in: Critical Care | Issue 3/2002

Abstract

There is important variation in the care of critically ill patients. While some of this variability is appropriate, and represents individually titrated care, residual variation indicates over- and under-use of precious resources and is clearly concerning. Recent advances in critical care medicine provide "road maps" to standardize care and use evidence-based medicine to improve patient outcomes. Knowledge about which therapies to use, and under what circumstances to use them, could form a basis for measuring the consistency and quality of our care processes. These simple process measures can be easily incorporated into daily rounds and serve to inform on the quality of our care.

Yu DT, Black E, Sands KE, Schwartz JS, Hibberd PL, Graman PS, Lanken PN, Kahn KL, Snydman DR, Parsonnet J, Moore R, Platt R, Bates DW, for the Academic Medical Center Consortium Sepsis Project Working Group: Severe sepsis: variation in resource and therapeutic modality use among academic centers. Crit Care 2003, 7: R24-R34. 10.1186/cc2171PubMedCentralCrossRefPubMed

Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, Parsonnet J, Panzer R, Orav EJ, Snydman DR: Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group. JAMA 1997, 278: 234-240. 10.1001/jama.278.3.234CrossRefPubMed

Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH: Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest 2002, 122: 262-268. 10.1378/chest.122.1.262CrossRefPubMed

Kollef MH, Sherman G, Ward S, Fraser VJ: Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999, 115: 462-474. 10.1378/chest.115.2.462CrossRefPubMed

Tilford JM, Simpson PM, Yeh TS, Lensing S, Aitken ME, Green JW, Harr J, Fiser DH: Variation in therapy and outcome for pediatric head trauma patients. Crit Care Med 2001, 29: 1056-1061. 10.1097/00003246-200105000-00037CrossRefPubMed

Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ: Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 2002, 30: 1870-1876. 10.1097/00003246-200208000-00033CrossRefPubMed

Jordan P, Hadcock W, Beaulieu C, Kamada S, Vomacka J, Garrett D, Frye L: Decreasing process variation in the care of carotid endarterectomy patients. Top Health Inf Manage 2001, 22: 24-34.PubMed

Lowers J, Gore MJ: Reducing variation in care. Qual Lett Healthc Lead 1999, 11: 2-7.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307CrossRefPubMed

10.

Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrell FE Jr, Wagner D, Desbiens N, Goldman L, Wu AW, Califf RM, Fulker-son WJ Jr, Vidaillet H, Broste S, Bellamy P, Lynn J, Knaus WA: The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996, 276: 889-897. 10.1001/jama.276.11.889CrossRefPubMed

11.

Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, Laporta DP, Viner S, Passerini L, Devitt H, Kirby A, Jacka M, Canadian Critical Care Clinical Trials Group: A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 2003, 348: 5-14. 10.1056/NEJMoa021108CrossRefPubMed

12.

Kac G, Durain E, Amrein C, Herisson E, Fiemeyer A, Buu-Hoi A: Colonization and infection of pulmonary artery catheter in cardiac surgery patients: epidemiology and multivariate analysis of risk factors. Crit Care Med 2001, 29: 971-975. 10.1097/00003246-200105000-00014CrossRefPubMed

13.

Mermel LA, Maki DG: Infectious complications of Swan-Ganz pulmonary artery catheters. Pathogenesis, epidemiology, prevention, and management. Am J Respir Crit Care Med 1994, 149: 1020-1036.CrossRefPubMed

14.

Hayes MA, Timmins AC, Yau EHS, Palazzo M, Hinds CJ, Watson D: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994, 330: 1717-1722. 10.1056/NEJM199406163302404CrossRefPubMed

15.

Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr, Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344: 699-709. 10.1056/NEJM200103083441001

16.

The ARDS Network Authors for the ARDS Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000, 342: 1301-1308. 10.1056/NEJM200005043421801CrossRef

17.

Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999, 340: 409-417. 10.1056/NEJM199902113400601CrossRefPubMed

18.

Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M: Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999, 354: 1851-1858. 10.1016/S0140-6736(98)12251-1CrossRefPubMed

19.

Kress JP, Pohlman AS, O'Connor MF, Hall JB: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000, 342: 1471-1477. 10.1056/NEJM200005183422002CrossRefPubMed

20.

van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001, 345: 1359-1367. 10.1056/NEJMoa011300CrossRefPubMed

21.

Martin TJ, Hovis JD, Costantino JP, Bierman MI, Donahoe MP, Rogers RM, Kreit JW, Sciurba FC, Stiller RA, Sanders MH: A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med 2000, 161: 807-813.CrossRefPubMed

22.

Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF: Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996, 335: 1864-1869. 10.1056/NEJM199612193352502CrossRefPubMed

23.

Valles J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, Fernandez R, Baigorri F, Mestre J: Continuous aspiration of sub-glottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995, 122: 179-186.CrossRefPubMed

24.

Cook DJ, Reeve BK, Guyatt GH, Heyland DK, Griffith LE, Buckingham L, Tryba M: Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA 1996, 275: 308-314. 10.1001/jama.275.4.308CrossRefPubMed

25.

Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group: Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Lancet 2000, 356: 2139-2143. 10.1016/S0140-6736(00)03495-4CrossRef

26.

Bernard GR, Luce JM, Sprung CL, Rinaldo JE, Tate RM, Sibbald WJ, Kariman K, Higgins S, Bradley R, Metz CA, et al.: High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med 1987, 317: 1565-1570.CrossRefPubMed

27.

Weinert CR, Gross CR, Marinelli WA: Impact of randomized trial results on acute lung injury ventilator therapy in teaching hospitals. Am J Respir Crit Care Med 2003, in press.

28.

Rubenfeld GD, Caldwell E, Hudson L: Publications of study results does not increase use of lung protective ventilation in patients with acute lung injury [abstract]. Am J Respir Crit Care Med 2003, 163: A295.

29.

Majumdar SR, Chang WC, Armstrong PW: Do the investigative sites that take part in a positive clinical trial translate that evidence into practice? Am J Med 2002, 113: 140-145. 10.1016/S0002-9343(02)01166-XCrossRefPubMed

30.

Lamas GA, Pfeffer MA, Hamm P, Wertheimer J, Rouleau JL, Braunwald E: Do the results of randomized clinical trials of cardiovascular drugs influence medical practice? The SAVE Investigators. N Engl J Med 1992, 327: 241-247.CrossRefPubMed

31.

Ketley D, Woods KL: Impact of clinical trials on clinical practice: example of thrombolysis for acute myocardial infarction. Lancet 1993, 342: 891-894. 10.1016/0140-6736(93)91945-ICrossRefPubMed

32.

Rotondi AJ, Sirio CA, Angus DC, Pinsky MR: A new conceptual framework for ICU performance appraisal and improvement. J Crit Care 2002, 17: 16-28. 10.1053/jcrc.2002.33033CrossRefPubMed

Title: Variation in sepsis care: a wake-up call
Authors: Mary E Hartman
Derek C Angus
Publication date: 01-06-2003
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2002
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc2191

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Variation in sepsis care: a wake-up call

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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