Recombinant activated protein C usage in Scotland: a comparison with published guidelines and a survey of attitudes

Puxty, A., McConnell, P., Crawley, S., McAree, S., Quasim, T. and Ramsay, S. (2011) Recombinant activated protein C usage in Scotland: a comparison with published guidelines and a survey of attitudes. Anaesthesia, 67(1), pp. 43-50. (doi: 10.1111/j.1365-2044.2011.06925.x)

Abstract

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ramsay, Dr Scot and Quasim, Professor Tara
• Authors: Puxty, A., McConnell, P., Crawley, S., McAree, S., Quasim, T., and Ramsay, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Anaesthesia
• ISSN: 0003-2409
• ISSN (Online): 1365-2044
• Published Online: 19 October 2011