(1) Dept of Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
(2) Clinical Nurse Coordinator, Tele-ICU, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Introduction: Mortality rates from severe sepsis /shock have declined with implementation of the Surviving Sepsis Guidelines in the western world. Unfortunately, lesser developed countries continue to exhibit high death rates. We hypothesized that this is because of poor adherence to the guidelines and we carried out this study to determine compliance and to identify variables that relate to improved compliance. Materials and Methods: Critical care providers were asked to fill out a survey instrument designed to assess compliance with the 2012 Surviving Sepsis Guidelines. Providers from countries located in the Eastern Mediterranean Region were sampled. The study protocol was approved by the Hospital Research Ethics committee. Results: 175 responses from 11 countries were recieved; 95 high-income (Saudi Arabia, Bahrain), 8 mid-income (Lebanon,Jordan,Turkey,Iran, Libya),72 low-income (Pakistan,Syria,West Bank & Gaza, Sudan). Compliance with the Resuscitation bundle was 66% and 47% with the Management bundle. Amongst the individual components, 84% (148) routinely measured lactate, 51% (89) give antibiotics within the first hour of sepsis, 36% (64) measure procalcitonin, 7% (12) routinely use colloidal fluids for resuscitation. 32% (56) do not use lung protective ventilation for patients with acute respiratory distress syndrome and 22% (39) use no stress ulcer prophylaxis. Compliance was significantly associated with 24 hour intensivist coverage, p=0.004; 1:1 nurse: patient ratio, p= 0.000; a rapid response service, p=0.001 and routine measurement of critical care performance indicators, p=0.029. Conclusions: Poor compliance with key recommendations may be responsible for the continued high mortality observed from severe sepsis and shock in these countries. Any effort to improve outcomes will need to address these knowledge and practice deficiencies.