(1573) Practice Variations Between New and Experienced Practitioners in Weight-Based Fluid Dosing in Sepsis

Introduction: Previous research on the influence of years of clinical experience on adherence to guideline recommendations is mixed. The 2021 Surviving Sepsis Campaign (SSC) Guidelines includes the recommended use of ideal body weight (IBW) to dose fluid resuscitation in septic shock. This study's purpose was to understand current practices and opinions regarding this recommendation with respect to years of experience. The hypothesis is that new practitioners will report higher degrees of guideline awareness and utilization compared to experienced practitioners.

Methods: A cross-sectional survey was electronically distributed to Society of Critical Care Medicine members. Demographics, practices, and opinions related to sepsis management were queried. Outcomes included assessment of practitioner use of guideline recommended IBW for dosing resuscitation fluids (i.e., 30 mL/kg) and opinion on their level of agreement with this recommendation. Respondents were grouped based on years of experience ( < 5, 5-10, 11-20, and >20 years) and outcomes were compared between groups using the Chi-squared test. Analyses were conducted using SPSS Version 29 with alpha < 0.05 considered significant.

Results: A total of 650 members participated in the survey, including 62.7% physicians, 15.5% pharmacists, 17.3% advanced practice providers, and 4.5% nurses/other. New practitioners ( < 5 years) comprised 26.6% of respondents, while 17.1%, 25.6%, and 30.7% had practiced for 5-10, 11-20, and >20 years, respectively. In non-obese patients, respondents with >20 years in practice were more likely to dose based on IBW (20%) than those with < 5 years (12%) (p=0.008). No difference was observed with obese patients. Practitioners’ opinions align closer with SSC recommendations, compared to actual practices.

Conclusions: Previous research demonstrate differing results when comparing years of experience with guideline adherence. This study showed that more experienced practitioners were more likely to follow the guideline recommended dosing weight for fluid administration in non-obese patients with sepsis compared to new practitioners. Overall guideline adherence was low across all groups suggesting substantial practice variation. Further research is needed to strengthen SSC guidelines to align clinical practice with recommendations.