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Open Access Research article

Statin therapy in critical illness: an international survey of intensive care physicians’ opinions, attitudes and practice

Manu Shankar-Hari123*, Peter S Kruger45, Stefania Di Gangi13, Damon C Scales67, Gavin D Perkins8, Danny F McAuley9 and Marius Terblanche123

Author Affiliations

1 Division of Asthma, Allergy and Lung Biology, King’s College London, London, UK

2 Critical Care and Anesthesia Research Group, King’s Health Partners Academic Health Sciences Centre, London, UK

3 Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK

4 Princess Alexandra Hospital, Wooloongabba, Brisbane, Australia

5 University of Queensland, Brisbane, Australia

6 Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada

7 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

8 Warwick Clinical Trials Unit, Warwick Medical, University of Warwick School, Warwick, UK

9 Centre for Infection and Immunity, The Queen’s University of Belfast, Belfast, UK

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BMC Clinical Pharmacology 2012, 12:13  doi:10.1186/1472-6904-12-13

Published: 28 June 2012

Abstract

Background

Pleotropic effects of statins on inflammation are hypothesised to attenuate the severity of and possibly prevent the occurrence of the host inflammatory response to pathogen and infection-related acute organ failure. We conducted an international survey of intensive care physicians in Australia, New Zealand (ANZ) and United Kingdom (UK). The aims of the survey were to assess the current prescribing practice patterns, attitudes towards prescribing statin therapy in critically ill patients and opinions on the need for an interventional trial of statin therapy in critically ill patients.

Methods

Survey questions were developed through an iterative process. An expert group reviewed the resulting 26 items for face and content validity and clarity. The questions were further refined following pilot testing by ICU physicians from Australia, Canada and the UK. We used the online Smart SurveyTM software to administer the survey.

Results

Of 239 respondents (62 from ANZ and 177 from UK) 58% worked in teaching hospitals; most (78.2%) practised in ‘closed’ units with a mixed medical and surgical case mix (71.0%). The most frequently prescribed statins were simvastatin (77.6%) in the UK and atorvastatin (66.1%) in ANZ. The main reasons cited to explain the choice of statin were preadmission prescription and pharmacy availability. Most respondents reported never starting statins to prevent (65.3%) or treat (89.1%) organ dysfunction. Only a minority (10%) disagreed with a statement that the risks of major side effects of statins when prescribed in critically ill patients were low. The majority (84.5%) of respondents strongly agreed that a clinical trial of statins for prevention is needed. More than half (56.5%) favoured rates of organ failure as the primary outcome for such a trial, while a minority (40.6%) favoured mortality.

Conclusions

Despite differences in type of statins prescribed, critical care physicians in the UK and ANZ reported similar prescription practices. Respondents from both communities agreed that a trial is needed to test whether statins can prevent the onset of new organ failure in patients with sepsis.

Keywords:
Survey; Statin; Sepsis; Critical care; Clinical trials