The Surviving Sepsis Guidelines have lost their way…

Hello everyone,

EM Basic will be back soon with new episodes but I am writing this post to bring your attention to the new 2018 Surviving Sepsis guidelines…and why I (and many others) think that they have to go.

Here’s the bottom line and the real sticking point: the 2018 Surviving Sepsis guidelines mandate antibiotics and 30 ml/kg fluid bolus now be given within 60 minutes of emergency department TRIAGE!?!?  This has zero evidence behind it and will only cause patient harm by rushing to implement antibiotics and fluids that most patients will not need.  Does anyone remember the “antibiotics within 4 hours of pneumonia diagnosis” debacle?

You learned from the sepsis update on this podcast that the goal of sepsis care (as stated by Scott Weingart from EmCrit) is that you don’t have to do a lot of crap, you just have to give a crap.  This means tailoring your interventions to what the patient needs- not a blind following of a rigid protocol or guidelines.  This tailored approach is supported by multiple multi-center international RCTs and it is what we should be doing in the ED for our patients with sepsis.

Josh Farkas and the EmCrit crew have spearheaded a petition to call for a retraction of the 2018 surviving sepsis guidelines and you should definitely read their take on this at the EmCrit page.  These guidelines were started with the best of intentions but have lost their way by mandating therapies that most patients won’t need.

If you want to contribute, go to the petition website and add your name to the list of those who think that the 2018 Surviving Sepsis guidelines should be retracted.

Until next time…

Steve