Among the CICM examiners' most favourite punching bags, none are most prominently featured in the exam than the Surviving Sepsis guidelines. Trainees are usually invited to "critically evaluate" the guidelines - which means, describe their rationale, explain the pros and cons and give evidence to support their "own practice" statement. Because this has long been as staple of the Fellowship Exam, to score less than 7/10 is inexcusable for anybody who's done any amount of preparation for this test, and all future versions of these questions should be viewed as easy marks by the savvy candidates.
If one were too junior to generate their own opinion of the 2012 guidelines, where would one turn? Literature comes to the rescue with prefabricated opinions from experts.
More recent entries, relevant to the new 2018 SSG:
One could do worse than regurgitating these expert opinions in the exam. For one, some of the quoted experts might be the actual CICM examiners. To render easier the process of retention and disgorgement, these opinions are distilled in the discussion below.
In brief summary:
Advantages of SSG:
Disadvantages of SSG:
Evidence in support of SSG:
Evidence against SSG:
Now, in some detail:
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.
Hicks, Peter, et al. "The surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008. An assessment by the Australian and New Zealand Intensive Care Society." Anaesthesia and intensive care 36.2 (2008): 149-151. - this article was also published in Critical care and Resuscitation - and this version is available for free.
Levy, Mitchell M., Laura E. Evans, and Andrew Rhodes. "The surviving sepsis campaign bundle: 2018 update." Intensive care medicine (2018): 1-4.
IDSA Sepsis Task Force Kalil Andre C Gilbert David N Winslow Dean L Masur Henry Klompas Michael. "Infectious Diseases Society of America (IDSA) POSITION STATEMENT: Why IDSA Did Not Endorse the Surviving Sepsis Campaign Guidelines." Clinical Infectious Diseases 66.10 (2017): 1631-1635.
Napolitano, Lena M. "Sepsis 2018: Definitions and Guideline Changes." Surgical infections 19.2 (2018): 117-125.
Pepper, Dominique J., et al. "Evidence Underpinning the US Government–Mandated Hemodynamic Interventions for Sepsis: A Systematic Review." Annals of Internal Medicine(2018).