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HWN Suggests

ACEP task force on septic shock should replace the Surviving Sepsis Campaign

The critical care community has long been plagued by a series of antiquated, overbearing guidelines created by the Surviving Sepsis Campaign (SSC). The campaign was originally sponsored by Eli Lilly and Edwards Life Sciences, as a commercial marketing campaign. The backbone of the original guidelines was a single center trial by Rivers, which has failed to be replicated. Nonetheless, despite new evidence, the guidelines have been highly resistant to change, often causing them to lag several years behind modern sepsis care.

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  Surviving Sepsis Campaign Guidelines

The Surviving Sepsis Campaign regularly develops and updates resources and implementation tools to further its mission of reducing sepsis and septic shock. With publication of 3 trials that do not demonstrate superiority of required use of a central venous catheter (CVC) to monitor central venous pressure (CVP) and central venous oxygen saturation (ScvO2) in all patients with septic shock who have received timely antibiotics and fluid resuscitation compared with controls or in all patients with lactate >4 mmol/L, the SSC Executive Committee has revised the improvement bundles...

 Petition to retire the surviving sepsis campaign guidelines

Concern regarding the Surviving Sepsis Campaign (SSC) guidelines dates back to their inception. Guideline development was sponsored by Eli Lilly and Edwards Life Sciences as part of a commercial marketing campaign. Throughout its history, the SSC has a track record of conflicts of interest, making strong recommendations based on weak evidence, and being poorly responsive to new evidence.

 Six myths promoted by the new surviving sepsis guidelines

The unfortunate reality is that the Rivers trial was a flimsy study. It was a single-center study with dodgy methodology, including mysterious disappearance of 25 patients who were randomized but never analyzed. Dr. Rivers had major conflicts of interest, including patenting a catheter to monitor svcO2. The Rivers trial and the Surviving Sepsis Campaign popularized sepsis protocols, which saved lives. Massive accomplishment. However, that doesn't validate the individual components of early goal-directed therapy. Any protocol involving early identification and intensive care of septic patients probably would have worked. Over time, nearly every component of early goal-directed therapy was disproven

Articles of Interest

Sepsis: What Works, What Doesn't?

Central lines are no longer thought to be mandatory for all sepsis patients, Dr. Whittle said. “We now have solid data saying that high-quality peripheral lines are safe for administration of low-dose vasopressors for a limited time. Now, if your patient is going to need pressors longer than that, or if they're going to need more ports than you can get in a peripheral line because you're administering numerous meds, sometimes you will need a central line. Over the last few years, my practice has evolved to where I initiate pressors more quickly and allow less hypotension, preferably almost none, but I initiate far fewer central lines.”

The Surviving Sepsis Campaign Bundle: 2018 Update

The most important change in the revision of the SSC bundles is that the 3-h and 6-h bundles have been combined into a single “hour-1 bundle” with the explicit intention of beginning resuscitation and management immediately.

The Surviving Sepsis Campaign: A Rush to Judgment

A new 1-hour sepsis care bundle was ill conceived and may have unintended negative consequences. In April 2018, the Surviving Sepsis Campaign (SSC) — an initiative sponsored by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine — issued guidelines that promote adherence to an “Hour-1 Bundle” for patients with suspected sepsis (Intensive Care Med 2018; 44:925). The bundle consists of five interventions to be initiated within 1 hour of the “time of triage in the emergency department or, if referred from another care location, from the earliest chart annotation consistent with all elements of sepsis (formerly severe sepsis) or septic shock ascertained through chart review.”

Sepsis Hero: Emanuel Rivers, MD, MPH

Dr. Rivers has been at the forefront of sepsis research and care for several years, and has published several articles on sepsis diagnosis and management. His landmark paper, published in November 2001, supported and expanded early goal directed therapy. This improved early sepsis care to all hospitalized patients who had signs of severe sepsis or septic shock.

A Users’ Guide to the 2016 Surviving Sepsis Guidelines

The 2016 Surviving Sepsis Guidelines have arrived, a remarkable document, all 67 pages with 655 references (12). We congratulate the lead authors and contributing committee members. With each iteration, the guidelines grow more complex and perhaps more challenging to utilize. We offer guidance toward effective application in clinical practice.

CMS Sepsis Measures Spark Controversy

Measures would likely result in overtreatment, critics say.

Doctors have resisted guidelines to treat sepsis. New study suggests those guidelines save lives

Even in the face of increased pressure from regulators, many doctors have failed to fully embrace early screening and treatment protocols for sepsis, an infection-related complication that afflicts tens of thousands of Americans every year and that can be life-threatening. Skeptics have argued that there haven’t been any comprehensive studies to support the notion that the protocols can actually save lives. On Sunday, however, the New England Journal of Medicine published a large study that could make doctors reconsider — and help hospitals address head-on one of the most common dangers their patients face.

How one hospital is beating sepsis and saving lives

The solution wasn’t fancy; there was no code to break. We simply made sure that all clinicians were aware of the warning signs of sepsis and set a low threshold for starting treatment. We also standardized treatment, adopting the evidence-based “three hour bundle.”

Sepsis Care – What’s New? The CMS Guidelines for Severe Sepsis and Septic Shock have arrived

The new CMS guidelines have caused some controversies within the emergency medicine community. Many providers have voiced their concerns that we will be harming patients with antibiotics and fluids they do not need.

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.

We are Complicit – A glimpse into the current state of Severe Sepsis/Septic Shock Quality Measures

I spent the afternoon wading through the proposed CMS sepsis measure. Anyone who has any experience with national quality measures understands just how painful a way this is to waste a few hours. Here is the issue...

Resources

Surviving Sepsis Campaign

The Surviving Sepsis Campaign (SSC), an initiative of the European Society of Intensive Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine, has been developed to improve the management, diagnosis, and treatment of sepsis.

International Sepsis Forum

The mission of the ISF is to improve the understanding and clinical management of patients with severe sepsis.

Sepsis Alliance

There is only one true goal for SA and the people who work behind the scenes: raising awareness of sepsis so it can be detected and treated early enough that no harm is done. Currently, every year in the United States, over 200,000 people die of sepsis. That is more people in one year than those who die of breast cancer, prostate cancer and AIDS, combined. SA can’t do it alone and this is where the work comes in.

The UK Sepsis Trust

The UK Sepsis Trust exists to fight this life-threatening condition, stop preventable deaths and support those affected by sepsis.