CHEST Guidelines-POINT--Should-the-Surviving-Sepsis-Campaign-Guidel (1)

POINT--Should-the-Surviving-Sepsis-Campaign-Guidel (1)

Pdf Summary

The critique against the Surviving Sepsis Campaign (SSC) guidelines, as presented by Paul E. Marik and colleagues, calls for their retirement due to several fundamental issues. The development of the guidelines was tied to commercial interests from their inception. Throughout the SSC's history, it has made strong recommendations based often on weak evidence and has been slow to integrate new findings. The original guidelines were heavily influenced by a single study on early goal-directed therapy, which subsequent research disproved key elements of. Despite this, SSC continued to endorse these therapies.<br /><br />A significant component of SSC guidelines is the requirement to complete specific treatment bundles in set timeframes, yet multiple studies have shown most elements of these bundles lack scientific support and don't improve patient outcomes. Particularly concerning is the new mandate to complete treatment protocols within one hour, despite no prospective evidence to recommend this change. The only generally beneficial component—the prompt administration of antibiotics—does not justify the entire bundle, nor its rigid timeline.<br /><br />Attempting to meet the one-hour bundle could lead to rash diagnoses and unnecessary treatment of non-septic patients, potentially causing harm. For instance, the obligatory 30 mL/kg fluid bolus might be harmful, and the aggressive timeline may push medical staff to make hasty decisions, disrupting care for other patients.<br /><br />These bundled care mandates prioritize rigid protocols over individualized patient care, which isn't supported by robust evidence. The authors argue that clinical guidelines should inform but not dictate specific treatments. They believe the SSC's approach may negatively impact patient care quality through hurried medical decisions and recommend developing new, evidence-based guidelines created with comprehensive systematic reviews. Thus, they advocate for retiring the SSC guidelines in favor of more flexible, evidence-supported alternatives.

Keywords

Surviving Sepsis Campaign

guidelines

Paul E. Marik

commercial interests

early goal-directed therapy

treatment bundles

patient outcomes

one-hour mandate

individualized care

evidence-based guidelines