CHEST Guidelines-POINT--Should-the-Surviving-Sepsis-Campaign-Guidel

POINT--Should-the-Surviving-Sepsis-Campaign-Guidel

Pdf Summary

The Surviving Sepsis Campaign (SSC) guidelines, aimed at managing sepsis, have been critiqued for potentially causing more harm than benefit. Concerns have been raised about the guidelines' foundation, notably their commercial origins and reliance on weak evidence. Despite evolving findings that question the efficacy of the original treatment protocols, the SSC has persisted in recommending them. <br /><br />The guidelines heavily emphasize strict adherence to treatment bundles, including fast-track procedures such as administering antibiotics and fluids within very tight timeframes (e.g., one-hour post-triage), which critics argue are not evidence-based, could lead to overdiagnosis, and pressure emergency departments (ED) into potentially harmful practices. Such practices can encourage excessive fluid administration and indiscriminate use of antibiotics, which do not necessarily improve patient outcomes and may, in fact, cause harm via iatrogenic volume overload or increase antibiotic resistance.<br /><br />Notably, a shift in 2018 condensed the previously separate 3- and 6-hour bundles into a 1-hour bundle without substantial supporting evidence, likened to a previous CMS initiative for pneumonia, which was retracted after causing more harm than benefit. The Infectious Disease Society of America (IDSA) refrained from endorsing the SSC guidelines due to concerns over excessive antibiotic use and rigid timelines.<br /><br />Furthermore, large randomized controlled trials have shown that individualized care might be as effective, if not more so, than the protocol-driven care advocated by SSC. Critics suggest that guidelines should instead encourage evidence-based practice and allow for clinician discretion. In light of these concerns, there's a call for the retirement of the SSC guidelines in favor of new directives developed through comprehensive, high-quality research involving a diverse range of stakeholders.

Keywords

Surviving Sepsis Campaign

sepsis management

guidelines critique

commercial origins

weak evidence

treatment bundles

antibiotic resistance

iatrogenic harm

individualized care

evidence-based practice