• James M O'Brien, Scott K Aberegg, Naeem A Ali, Gregory B Diette, and Stanley Lemeshow.
• Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Center for Critical Care, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH 43210, USA. james.obrien@osumc.edu
• J Crit Care. 2010 Dec 1;25(4):658.e7-15.

PurposeWe sought to evaluate factors associated with choices about provided care for patients with septic shock, including the use of drotrecogin α (activated) (DAA).Materials And MethodsWe administered a mail-based survey to a random sample of intensivists. Study vignettes presented patients with septic shock with identical severity of illness scores but different ages, body mass indices, and comorbidities. Respondents estimated outcomes and selected care beyond standardized initial care (eg, antibiotics) for each hypothetical patient.ResultsFor most vignettes (99.1%), respondents added care, most commonly low tidal volume ventilation (87.6%) and enteral nutrition (73.3%). Choosing to administer DAA was not associated with predictions about mortality or bleeding. Vignettes with early-stage lung cancer were less likely to receive DAA. Time since medical school graduation was also associated with lower odds of selecting DAA. Most respondents (52.6%) chose identical care for all 4 completed vignettes.ConclusionsThere was wide variability in the therapeutic choices of respondents. The use of DAA was not associated with perceived risk of mortality or bleeding, as recommended by consensus guidelines. Physicians appear to base treatment decisions in septic shock on a consistent pattern of practice rather than estimates of patient outcome.Copyright © 2010 Elsevier Inc. All rights reserved.

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