Current Practices and Opinions Related to Hemodynamic Optimization in Patients With Sepsis: An International Survey

BACKGROUND: The Surviving Sepsis Campaign guidelines were last updated in 2021, with many recommendations based on evidence of low or very low quality. OBJECTIVE: To assess practices and opinions regarding hemodynamic optimization in patients with sepsis and the adoption of updated recommendations. METHODS: A cross-sectional survey of members of the Society of Critical Care Medicine addressed practices and opinions regarding initial fluid resuscitation and thresholds for initiation of adjunctive vasopressors and corticosteroids. Responses were analyzed for patients with vs without obesity and stratified by respondent profession and experience. The primary outcome was guideline-suggested use of ideal body weight to dose initial fluids in patients without obesity. Variables were compared using the χ2 test, with P < .05 indicating statistical significance. RESULTS: Completed questionnaires were returned by 485 society members. In patients without obesity, 17% of respondents dosed initial resuscitation fluids by using ideal body weight, whereas 80% and 3% used total and adjusted body weights, respectively. Respondents with more than 20 years in practice were more likely to use ideal body weight (20%) than those with less than 5 years (12%) (P = .008). In terms of opinions, 57% of respondents preferred use of total body weight in patients without obesity, whereas 37% and 6% preferred ideal body weight and adjusted body weight, respectively. CONCLUSIONS: This study showed differences in practices based on experience. Clinicians' opinions aligned more closely with guideline statements than did actual practices.