Krzych Łukasz J, Wiórek Agnieszka, Zatorski Paweł, Gruca Karol, Stefańska-Wronka Karina, Trzebicki Janusz
Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 14 Medyków Street, 40-752 Katowice, Poland.
First Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, 02-005 Warsaw, Poland.
Healthcare (Basel). 2021 Feb 1;9(2):140. doi: 10.3390/healthcare9020140.
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.
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.
Sepsis diagnosis was primarily based on clinical evaluation (ICUs: 94%, non-ICUs: 62%; = 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.
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.
脓毒症和脓毒性休克是预后不良风险很高的医疗急症。我们调查了波兰“拯救脓毒症运动”（SSC）指南与临床实践之间的对应关系，特别关注重症监护病房（ICU）和非ICU环境之间的差异以及波兰国内的地区差异。
对波兰人口最多的三个地区——马佐夫舍省、西里西亚省和大波兰省的60家医院进行随机抽样，开展基于网络的问卷调查研究。基于最新版的SSC指南编制了一份包含19个条目的问卷。
脓毒症诊断主要基于临床评估（ICU：94%，非ICU：62%；P = 0.02）。在进行血培养以鉴定病原体方面（ICU的频率是其两倍）以及拥有根据临床情况调整抗菌治疗的医院操作程序方面（相差17%），ICU和非ICU之间存在显著差异。70%的病例在入住ICU后需要调整经验性抗菌治疗。在液体反应性评估方法以及用于治疗脓毒性休克的儿茶酚胺和液体类型方面，ICU与非ICU有所不同。在使用儿茶酚胺之前施加的平均液体负荷为25.8±10.6 mL/kg。去甲肾上腺素是用于治疗休克的一线药物，平衡晶体液在ICU和非ICU中均更受青睐。
波兰医院对SSC指南的依从性不足，尤其是在ICU之外。需要对医疗保健专业人员进行教育，以使该领域的知识和态度至少达到可接受的水平。
