Are adequate fluid challenges prescribed for severe XXXX ?

@entity1 @entity295 @entity64807
PURPOSE: Managing severe @entity295 early has several benefits. Correct early management includes delivering an appropriate fluid challenge. The purpose of this paper is to assess whether junior doctors prescribe adequate fluid challenges to severely septic @entity1 . DESIGN/METHODOLOGY/APPROACH: A questionnaire outlining three scenarios, each involving a @entity1 with severe @entity295 , but with varying weights (50/75/100 kg), was distributed to junior doctors, working in two UK hospitals, managing surgical @entity1 . @entity1 were asked the fluid volume challenge that they would prescribe for each @entity1 . Responses were compared with the Surviving Sepsis Campaign's recommended volume during the study (20 ml/kg). FINDINGS: Totally, 77 questionnaires were completed. There were 15/231 (6.5 per cent) correct responses. The median volume chosen in each scenario was 500 ml, equating to 5-10 ml/kg. There was no significant difference between doctor grades ( @entity64807 ) in any scenario. With most junior doctors (FY1), there was no difference in responses according to weight; for SHOs the only significant difference was between the 75 and 100 kg scenarios. PRACTICAL IMPLICATIONS: Junior doctors are not following guidelines when prescribing fluid challenges to severely septic @entity1 , giving too little and not adjusting volume according to body weight. This implies that high-prevalence, high-mortality conditions are not being treated appropriately by those most likely to treat these @entity1 . More teaching, training and reassessment is required to improve care. ORIGINALITY/VALUE: This, the first case-based survey the authors could find, highlights an issue requiring significant improvement. The implications are likely to be relevant to clinicians in all UK hospitals.
