Ron, I agree with you. It is not any individual part of the protocol that makes the difference. It is early recognition, appropriate antibiotic and fluid management altogether. In addition, the end goal must be tailored to the individual patient.
Jeffrey, protocols do not save lives, health care professionals do. Riad Cachecho,MD,MBA Director of Trauma Crozer Chester Medical Center One Medical Center Boulevard Vivaqua Pavillion, suite 440 Upland, PA 19013 610-447-6090 THIS EMAIL CONTAINS CONFIDENTIAL INFORMATION. ANY INFORMATION CONTAINED IS USED FOR PEER REVIEW PURPOSES ONLY. ________________________________ From: [email protected] [mailto:[email protected]] On Behalf Of Jeffrey R Hanlon RN Sent: Monday, December 19, 2011 10:27 PM To: [email protected]; [email protected] Cc: [email protected] Subject: Re: [Sepsis Groups] SSC guidelines All I can say is the protocol has and continues to save lives! Jeffrey R Hanlon RN Stamp Out Sepsis -----Original Message----- From: [email protected] To: Joan Greene Cc: sepsisgroups Sent: Thu, Dec 15, 2011 3:46 am Subject: Re: [Sepsis Groups] SSC guidelines Hi Joan, My views (for what they're worth): * Key issue is ScvO2 as sole indicator of O2 delivery. Agree other modalities of assessment of volume responsiveness and O2 delivery have equal or greater role, but I believe answer lies in a colleciton of clinical information: dangerous for anyone to run too fast with a single modality! * CVC is necessary for a majority of these patients for pressors/ tropes anyway. The authors don't argue against CVC but against over-reliance on CVP and ScvO2. Pragmatically, we need to build a larger picture: we assimilate informaiton from multiple sources to build our picture * Slight concerns with article. It confuses septic shock with severe sepsis which is not helpful or appropriate (see criteria fig 1). Referencing is somewhat author-centric Summary: Don't let this hold you back. EDs get excited about EGDT and forget the basics. Let's try not to get hung up on individual modalities (esp until we have ARISE/ ProCESS/ ProMISe) but recognise and intervene quickly using the monitoring strategies we have to hand and an assimilation of information. Rivers' protocol is good- and prob better than random care- but no-one ever suggested it was the ultimate answer! What do others think? kind regards Ron On Mon, Dec 12, 2011 at 4:37 AM, Joan Greene <[email protected]> wrote: Has anyone else received push-back in their early goal-directed therapy protocols after the attached article was published? We recently implemented the SSC guidelines for EGDT in our hospital by using a screening algorithm to activate a sepsis response team. The response team follows the 6-hour bundle. Now, we have some physicians who want to revisit the need for a central line based on this article. The bundle cannot be followed without a central line to measure the CVP and/or ScvO2 monitoring. I would appreciate any comments. Thank you. Joan Greene San Diego -- Dr Ron Daniels Suspect Sepsis: save someone's life today. Sign our e-petition at http://epetitions.direct.gov.uk/petitions/19602 Fellow: NHS Improvement Faculty Chair: Surviving Sepsis Campaign United Kingdom Chair: United Kingdom Sepsis Group Member of Congress: Global Sepsis Alliance Survive Sepsis Programme Director First Trustee: U.K Sepsis Trust Twitter: @sepsisuk _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
