Outline the strengths and limitations of the current Surviving Sepsis Campaign Guidelines, using examples to illustrate your points.
Examiners' comments: Candidates appeared to have a lack of understanding of the SSC Guidelines and were unable to discuss their strengths and weaknesses. Many candidates focused on EGDT alone.
In response to the Examiner's comment, one might counter by saying that the SSG are so heavily based upon EGDT that a discussion of one is by necessity a discussion of the other. The examiners would counter by pointing out that only 9% of people passed.
It may well be that these candidates in their susceptible state had erroneously conflated this question with Question 16 from the second paper of 2013, having obviously done all the past papers back to front.
A long rambling critique of the EGDT approach is already available elsewhere, and the reader will not be subjected to it here. A distillate of expert opinion regarding the SSG is also available. What follows below is a summary of that summary, hopefully incorporating the important points made in the college model answer.
High quality of the presented package
Evidence in defence of the guidelines
Arguments against bundled care in general:
Objections on the basis of methodology:
Objections to the guidelines themselves:
Objections to the evidence offered in support of widespread implementation:
Empirical evidence against the use of the guidelines:
Vo, Mai, and Jeremy M. Kahn. "Making the GRADE: how useful are the new Surviving Sepsis Campaign guidelines?." Critical Care 17.6 (2013): 328.
Marik, Paul E., Karthik Raghunathan, and Joshua Bloomstone. "Counterpoint: are the best patient outcomes achieved when ICU bundles are rigorously adhered to? No." CHEST Journal 144.2 (2013): 374-378.
Dellinger, R. Phillip, and Sean R. Townsend. "Rebuttal From Drs Dellinger and Townsend." CHEST Journal 144.2 (2013): 378-379.
Marik, Paul E., Karthik Raghunathan, and Joshua Bloomstone. "Rebuttal From Dr Marik et al." CHEST Journal 144.2 (2013): 379-380.
Chawla, Shalinee, and Jonas P. DeMuro. "Current controversies in the support of sepsis." Current opinion in critical care 20.6 (2014): 681-684.
Marik, Paul E. "Surviving sepsis: going beyond the guidelines." Annals of intensive care 1.1 (2011): 1-6.
Marik, Paul E. "Surviving sepsis." Critical care medicine 41.10 (2013): e292-e293.
Marik, Paul E. "Early management of severe sepsis: concepts and controversies." CHEST Journal 145.6 (2014): 1407-1418.
Kevin Klauer. "Sepsis: Unbundling the Bundle" in EP Monthly on May 24, 2012.
Priebe, Hans-Joachim. "Goal-directed resuscitation in septic shock." The New England journal of medicine 372.2 (2015): 189-189.
Kaukonen, Kirsi-Maija, et al. "Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012."Jama 311.13 (2014): 1308-1316.
Levy, Mitchell M., et al. "Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study." The Lancet infectious diseases 12.12 (2012): 919-924.
"Australia’s high survival rates shed doubt on global sepsis guidelines" - a press release by Monash University, home of ARISE.
Ferrer, Ricard, et al. "Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain." Jama 299.19 (2008): 2294-2303.
Barochia, Amisha V., et al. "Bundled care for septic shock: an analysis of clinical trials." Critical care medicine 38.2 (2010): 668.