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Recombinant activated protein C usage in Scotland: a comparison with published guidelines and a survey of attitudes *
Author(s) -
Puxty A.,
McConnell P.,
Crawley S.,
McAree S.,
Quasim T.,
Ramsay S.
Publication year - 2012
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2011.06925.x
Subject(s) - medicine , recombinant dna , intensive care unit , sepsis , audit , emergency medicine , protein c , intensive care medicine , biochemistry , chemistry , management , economics , gene
Summary Severe sepsis is a common cause of admission to the intensive care unit and is associated with a high hospital mortality. This audit explored the current use of, and attitudes towards, recombinant activated protein C therapy across Scotland, and compared these with current guidance. Patients with severe sepsis were followed for three days. Consideration and/or usage of recombinant activated protein C were compared with two different guidelines. Ninety‐seven patients were admitted to the intensive care unit over the audit period. Recombinant activated protein C was used in nine of these patients. Depending on the criteria used, between 50% and 81% of the patients who qualified for recombinant activated protein C therapy did not receive it. Subsequent to the audit, a survey was performed to study intensive care unit consultants’ attitudes to recombinant activated protein C therapy. A total of 125 consultants responded to the survey (77%). Of these, 104 (83%) stated that they used recombinant activated protein C in their clinical practice, 56 (52%) of whom prescribed it to patients with two‐organ failures and an Acute Physiology and Chronic Health Evaluation II score of ≥ 25. Thirty‐nine respondents (38%) stated that two‐organ failures alone would be an adequate trigger for therapy. We conclude that recombinant activated protein C is potentially under‐used to treat severe sepsis. Many consultants seem to reserve the drug for the most severely ill sub group of patients.