在脓毒症的初始治疗中,遵守《日本脓毒症和脓毒性休克管理临床实践指南2024》的全国性调查。

IF 4.7 2区 医学 Q1 CRITICAL CARE MEDICINE
Takehiko Oami, Daisuke Kasugai, Kazuma Yamakawa, Tadashi Matsuoka, Kenichi Kano, Yoshitaka Aoki, Tomoaki Yatabe, Nobuaki Shime, Taka-Aki Nakada
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引用次数: 0

摘要

背景:日本败血症和脓毒性休克管理临床实践指南2024 (J-SSCG2024)的制定是为了提高各种临床环境中败血症护理的标准化和质量。然而,日本医疗保健专业人员对这些建议的实际依从性仍不清楚。本研究的目的是评估J-SSCG2024的依从性模式,并确定与临床实践变化相关的因素。方法:我们针对医疗保健专业人员进行了一项全国性的基于网络的横断面调查,管理一份问卷,其中包括23个项目,反映了J-SSCG2024对败血症初始管理的关键建议,以及人口统计学和专业背景信息。进行聚类分析以确定不同的粘附模式。亚组分析探讨被调查者特征与指南依从性之间的关系。此外,还进行了敏感性分析,以评估不同簇数的结果的稳健性。结果:共有734名卫生保健专业人员参与调查,其中临床经验20年以上的医生居多(92.4%),占54.0%。高依从性观察到的建议,如血液净化和使用一线血管加压药物。然而,在辅助治疗和初始复苏相关的实践中发现了实质性的变化,特别是关于血管加压素启动的时间和β受体阻滞剂的使用。聚类分析显示了四种不同的依从性特征。较高的依从性与急诊和重症监护医学方面的专业知识、与重症监护病房或急诊科的联系以及每月处理脓毒症患者数量的增加有关。这些发现在敏感性分析中是一致的。结论:这项全国性调查根据日本临床医生对J-SSCG2024的依从性确定了特征集群。有针对性的实施策略对于提高指南的采用至关重要,特别是在专业重症监护环境之外的临床医生中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Nationwide survey of adherence to the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024 in the initial management of sepsis.

Background: The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock 2024 (J-SSCG2024) were developed to improve the standardization and quality of sepsis care across various clinical settings. However, real-world adherence to these recommendations among healthcare professionals in Japan remains unclear. The objective of this study was to assess patterns of adherence to the J-SSCG2024 and identify factors associated with variation in clinical practice.

Methods: We conducted a nationwide web-based cross-sectional survey targeting healthcare professionals, administering a questionnaire that included 23 items reflecting the key J-SSCG2024 recommendations for the initial management of sepsis, along with demographic and professional background information. Cluster analysis was performed to identify the distinct adherence patterns. Subgroup analyses were conducted to explore the association between respondent characteristics and guideline compliance. Additionally, sensitivity analyses were performed to evaluate the robustness of the findings across distinct cluster numbers.

Results: A total of 734 healthcare professionals participated in the survey, most of whom were physicians (92.4%) with over 20 years of clinical experience (54.0%). High adherence was observed for recommendations, such as blood purification and the use of first-line vasopressors. However, substantial variation was detected in practices related to adjuvant therapies and initial resuscitation, particularly regarding the timing of vasopressor initiation and the use of beta-blockers. Cluster analysis revealed four distinct adherence profiles. Higher adherence was associated with expertise in emergency and critical care medicine, affiliation with intensive care units or emergency departments, and a higher number of patients with sepsis managed monthly. These findings were consistent across the sensitivity analyses.

Conclusions: This nationwide survey identified characteristic clusters based on adherence to the J-SSCG2024 among Japanese clinicians. Targeted implementation strategies are essential to enhance guideline adoption, particularly among clinicians outside specialized critical care settings.

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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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