CHEST Guidelines-Response

Response_chest (1)

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This letter to the editor, authored by Drs. Sarah J. Lee, Kannan Ramar, John G. Park, Ognjen Gajic, and Rahul Kashyap from the Division of Pulmonary and Critical Care Medicine at Mayo Clinic, addresses feedback from Drs. Adrish and Soto regarding their previous article published in CHEST. The initial article focused on the correlation between increased fluid administration in the first three hours of sepsis resuscitation and reduced mortality. The authors acknowledge the potential for human error due to electronic medical records, but emphasize that the data was meticulously collected, checked, and validated over several years via real-time entry and automatic capture of vital metrics in the ICU Datamart database.<br /><br />The authors note that while retrospective studies have inherent limitations compared to prospective randomized controlled trials, their study took measures to integrate variables like age, APACHE, and SOFA scores to account for chronic conditions and acute illness severity, though they concede that unmeasured confounders might introduce bias.<br /><br />In relation to the Protocolized Care for Early Septic Shock (ProCESS) trial, which enrolled patients shortly after sepsis recognition, the authors argue that since all participant groups received similar fluid amounts before study randomization, the ProCESS trial results do not necessarily contradict their findings on fluid administration's efficacy in reducing mortality.<br /><br />The authors declare no conflicts of interest and reference their original study, as well as supporting literature on the informatics infrastructure for syndrome surveillance and other related protocols in critical care settings. The authors remind that reproduction of the article requires permission from the American College of Chest Physicians, who published the original work.

Keywords

sepsis resuscitation

fluid administration

mortality reduction

ICU Datamart

retrospective study

ProCESS trial

critical care

Mayo Clinic

electronic medical records

syndrome surveillance