Now @Manu_Malbrain arguing for the retirement of the surviving Sepsis guidelines #lives2018
The fall in Sepsis mortality hasn’t coincided with the introduction of the guidelines #lives2018 🤔
Is the pro-con debate of the surviving Sepsis guidelines nothing more than a liberal vs restrictive fluid argument? #Lives2018
The guidelines support lactate guided therapy...
However that’s full of holes intensivecarenetwork.com/understanding-… #lives2018
This is my bugbear with the guidelines.
30ml/kg is a lot of fluid.
The effect of a bolus is short lived and may be harmful... #lives2018
Fluid overload has multi-organ effects.
Tailored care, carefully titrate to response, may be better than a “one size fits all” bundle... @Manu_Malbrain #lives2018
A MAP target of 65 may not be the right one- we haven’t done trials to confirm this
(SEPSISPAM had a bunch of interesting secondary outcomes mind. thebottomline.org.uk/summaries/icm/…) #lives2018
The guidelines And bundles are based on a lot of correlative studies (Kumar and antibiotics, Seymour and bundles)
But correlation is not causation.
So you end up with recommendations based on low quality evidence #lives2018
Only 7% of current guideline recommendations are based on strong evidence
And if the bundles are so great, why was there a reversal on the implementation of the 1 hour bundle? #lives2018
Now in the opposing corner, Mitchell Levy #lives2018
He asks the question:
If your relative got sick, would you want them to go to a guideline positive hospital, or a free for all hospital?
Majority chose hospital 1
(Isn’t this a straw man argument @emcrit @avkwong @EMNerd_?) #lives2018
CLASS MOMENT.
Mitchell’s screen suddenly goes blank
Michell: “Manu, is that you?” #lives2018
This is a superb argument.
Our perceived adherence to guidelines isn’t as good as our actual adherence (ping @docpgb) #lives2018
Here is great data (soon to be published in @ATSBlueEditor ) showing an association with bundle compliance and improved Sepsis mortality
And a suggestion of a dose effect too (more compliance= better mortality) #lives2018
Hey @PulmCrit and @emcrit getting a pasting from Mitchell #lives2018
He didn’t appreciate the Darth Vader/Death Star/secret police comparisons 😉 emcrit.org/pulmcrit/ssc-p…
Shots fired at Mervin Singer!!!!
“He doesn’t let antibiotics be started by a resident without them calling him directly”
“WTF?”
-Mitchell Levy #lives2018
🤣
Mitchell accepts that identifying infection can be challenging in some patients jamanetwork.com/journals/jama/… #lives2018
That doesn’t mean we shouldn’t try to help the ones who turn out to be septic...
And giving a single dose of antibiotics doesn’t mean we need to continue it...
Mitchell Kevy clearing up some myths:
You don’t need to COMPLETE the one hour bundle in the first hour
Time zero for the most part now is accepted as time of presentation
#lives2018
Summary from Mitchell #lives2018
Rebuttal from @Manu_Malbrain:
Guidelines should remain guidelines.
They should never replace the mind of an attentive clinician.
Rebuttal from Mitchell Levy:
Local clinicians are the very people engaging with the guidelines.
#lives2018
“If clinicians are not reminded, they will fail to do the right thing” #lives2018
This is amazing- Mervin Singer is in the audience and is shooting down Mitchell Levy!!
U.K. data- NO CHANGE in Sepsis mortality despite the SSC guidelines
-Mervyn Singer #lives2018
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