CHEST Guidelines-Rebuttal-From-Drs-Marik,-Farkas,-Spiegel-et a

Rebuttal-From-Drs-Marik,-Farkas,-Spiegel-et a

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The document presents a rebuttal to the Surviving Sepsis Campaign (SSC) guidelines for managing sepsis. Drs. Marik, Farkas, Spiegel, and Weingart critique the studies supporting the SSC, arguing that these studies lack robust scientific evidence demonstrating that the SSC has improved mortality rates. They note that several observational studies suggest improved outcomes with SSC guidelines; however, they attribute this to the Hawthorne Effect—where changes occur because those involved are aware they are being observed—rather than the guidelines themselves. Furthermore, the authors highlight how correlations between interventions and mortality rates in these studies are confounded by other variables, such as the overall health status of patients.<br /><br />The rebuttal points out that while sepsis mortality has decreased over time, similar trends are evident in countries like Australia and New Zealand, which rejected SSC guidelines. This suggests that improvements in sepsis outcomes are more likely due to advancements in critical care rather than the SSC.<br /><br />Critically, the authors emphasize that randomized clinical trials (RCTs), which provide stronger evidence, do not support SSC guidelines. They point out that these trials have shown no necessity for invasive early goal-directed therapy, once a cornerstone of SSC treatment, and that some SSC-recommended treatments were found ineffective.<br /><br />The rebuttal argues that the SSC's 2018 revision imposing a 1-hour bundle for sepsis treatment is arbitrary and lacks supporting evidence. The authors call for strong recommendations on sepsis management to be based on validated scientific evidence, highlighting a moratorium placed on the 2018 SSC bundles by leading critical care organizations. They overall urge a more rigorous scientific basis for international guidelines on sepsis management.

Keywords

Surviving Sepsis Campaign

sepsis management

SSC guidelines

Hawthorne Effect

randomized clinical trials

critical care

mortality rates

early goal-directed therapy

scientific evidence

1-hour bundle