Statin therapy in critical illness an international survey of intensive care physicians’ opinions, attitudes and practice 英文参考文献.docVIP

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Statin therapy in critical illness an international survey of intensive care physicians’ opinions, attitudes and practice 英文参考文献.doc

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Statin therapy in critical illness an international survey of intensive care physicians’ opinions, attitudes and practice 英文参考文献

Shankar-Harietal.BMCClinicalPharmacology2012,12:13 /1472-6904/12/13 RESEARCH ARTICLE OpenAccess Statintherapyincriticalillness:aninternational surveyofintensivecarephysicians’opinions, attitudesandpractice ManuShankar-Hari1,2,3*,PeterSKruger4,5,StefaniaDiGangi1,3,DamonCScales6,7,GavinDPerkins8, DannyFMcAuley9andMariusTerblanche1,2,3 Abstract Background:Pleotropiceffectsofstatinsoninflammationarehypothesisedtoattenuatetheseverityofand possiblypreventtheoccurrenceofthehostinflammatoryresponsetopathogenandinfection-relatedacuteorgan failure.WeconductedaninternationalsurveyofintensivecarephysiciansinAustralia,NewZealand(ANZ)and UnitedKingdom(UK).Theaimsofthesurveyweretoassessthecurrentprescribingpracticepatterns,attitudes towardsprescribingstatintherapyincriticallyillpatientsandopinionsontheneedforaninterventionaltrialof statintherapyincriticallyillpatients. Methods:Surveyquestionsweredevelopedthroughaniterativeprocess.Anexpertgroupreviewedtheresulting 26itemsforfaceandcontentvalidityandclarity.ThequestionswerefurtherrefinedfollowingpilottestingbyICU physiciansfromAustralia,CanadaandtheUK.WeusedtheonlineSmartSurveyTMsoftwaretoadministerthe survey. Results:Of239respondents(62fromANZand177fromUK)58%workedinteachinghospitals;most(78.2%) practisedin‘closed’unitswithamixedmedicalandsurgicalcasemix(71.0%).Themostfrequentlyprescribed statinsweresimvastatin(77.6%)intheUKandatorvastatin(66.1%)inANZ.Themainreasonscitedtoexplainthe choiceofstatinwerepreadmissionprescriptionandpharmacyavailability.Mostrespondentsreportedneverstarting statinstoprevent(65.3%)ortreat(89.1%)organdysfunction.Onlyaminority(10%)disagreedwithastatementthat therisksofmajorsideeffectsofstatinswhenprescribedincriticallyillpatientswerelow.Themajority(84.5%)of respondentsstronglyagreedthataclinicaltrialofstatinsforpreventionisneeded.Morethanhalf(56.5%)favoured ratesoforganfailureastheprimaryoutcomeforsuchatrial,whileaminority(40.6%)favouredmortality. Conclusions:Despitedifferencesintypeofstatinsprescribed,cr