A Petition of the 2018 Surviving Sepsis Campaign Guidelines

Authors: Brit Long, MD (@long_brit), Alex Koyfman, MD (@EMHighAK), and Manpreet Singh, MD (@MprizzleER)

Sepsis is always a hot button issue, with several recent developments in terms of fluid resuscitation, antibiotic administration, peripheral vasopressor use, and qSOFA versus SIRS moving our care forward. As in many other conditions, however, society guidelines play a major role in the emergency medicine evaluation and management of patients with sepsis. The major society for sepsis is the Surviving Sepsis Campaign (SSC). Unfortunately, the SSC has demonstrated several faults: major conflicts of interest, recommendations lagging behind updated literature, and recommendations based on poor evidence. For example, remember Activated Protein C and its recommendations from the SSC? Many of the guideline authors recommending its use possessed conflicts of interests with the manufacturing company.

The SSC also has made sepsis care at times difficult, basing strict recommendations with fixed time frames, often bundled together. Many of these recommendations are not supported by strong literature. Even though many experts in sepsis care have discussed their concerns with prior SSC recommendations, the society has failed to respond. The SSC will soon be releasing their 2018 sepsis recommendations. We will not go into an in-depth discussion of prior failures, but the 2018 guidelines recommend providing a 30 cc/kg IV fluid bolus with broad-spectrum antibiotics within 60 minutes of ED triage.  

For more information, please see this EMCrit post. 

This has the potential to worsen our care of patients with sepsis, and we, among many others, have signed an international petition.  This petition seeks to withdraw the new SSC guidelines, in favor of evidence-based care, rather than strict recommendations based on poor information.

If you are concerned over these changes, then please sign this petition.

Sincerely,

Scott Aberegg MD MPH

Jennifer Beck-Esmay MD

Steven Carroll DO MEd

Joshua Farkas MD

Jon-Emile KennyMD

Alex Koyfman MD

Michelle Lin MD

Brit Long MD

Manu Malbrain MD PhD

Paul Marik MD

Ken Milne MD

Justin MorgensternMD

Segun Olusanya MD

Salim Rezaie MD

Philippe Rola MD

Manpreet Singh MD

Rory Speigel MD

Reuben Strayer MD

Anand Swaminathan MD

Adam Thomas MD

Scott Weingart MD

Lauren Westafer DO MPH

References:

Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle:  2018 update. Intensive Care Medicine. Electronic publication ahead of print, PMID 29675566.