Question 19

Outline the strengths and weaknesses surrounding the Surviving Sepsis Campaign Guidelines of 2003 (which have been endorsed by the various National Societies of Critical Care Medicine).

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College Answer

Strengths include

1)  A major document summarizing a large body of evidence towards the management of a common clinical problem akin to the BTF guidelines for neurotrauma

2)  Also provided access to a major literature review on the subject

Criticisms include

a)  Strength of evidence: More than 50% of recommendations are Level E (case reports, expert opinions, non-randomised historical controls)
b)  Only 5 had a Level A recommendation ( based on RCTs – which included avoiding supranormal DO2, avoiding high dose steroids etc)
c)  Extrapolation of evidence from non-septic studies

d)  Significant omissions : - Eg SDD
e)  Perception that the sepsis bundles suggested by the campaign may be an over interpretation
f)   That there was industry sponsorship in the development of this process


In order to tailor this answer to the environment of late 2014-early 2015, I direct the gentle reader to Question 1 from the first paper of 2014, where the discussion answers this question with specific reference to the modern (2012) incarnation of the Surviving Sepsis Guidelines. The guidelines themselves have been subjected to a thorough autopsy at LITFL, and I merely summarise the key points into an easily retained morsel for the time-poor exam candidate.

Paul Marik tore apart the guidelines in 2011, and his article is the definitive source for this answer.

To answer this question to a satisfactory depth, a detailed critique of the 2012 Surviving Sepsis Guidelines is also available in the Required Reading section.