Apology for my error - SSC did indeed recommend use of Xigris. However, SSC data base would accept patients from institutions whose protocol excluded use in all patients due to cost.
Ron Elkin On Mon, Dec 12, 2011 at 11:12 AM, Ron Elkin <[email protected]> wrote: > My $0.02 > > Debates, critiques, further studies, and refinements of EGDT should be > welcomed. On consideration of each, one must ask 2 questions: > > 1) Where is the proof that the original EGDT study was fatally flawed? > Surely not in the *Wall Street Journal*. > 2) Is there convincing evidence-based/outcomes proof, rather than > speculation, that other resuscitation strategies offer equal or greater > mortality benefit? > > Perhaps due to my own bias or ignorance, I have never read or heard a > convincing answer to either question. > > There are other questions and observations to consider: > 1) SSC Guidelines have never included a recommendation to use the Edwards > catheter or other continuous ScvO2 measuring devices. What is the evidence > that Edwards Lifesciences had a corrupting influence on the guidelines? > > 2) Ely Lily sponsored the guideline process and undoubtedly had an > interest in sales of Xigris. Was that a corrupting influence and a negating > force for the remaining 51 (2004) and 84 (2008) recommendations by SSC that > had nothing to do with Xigris? > > 3) Ely Lily was not present in the room when guidelines were written and > had no editorial influence on the recommendations. SSC did not recommend > use of Xigris. They simply recommended institutional protocols to consider > its use. An institutional protocol stating the drug could never be used due > to cost would have satisfied the guideline requirements. > > 4) Some detractors of EGDT focus upon individual elements of the bundles, > such as failure of CVP to accurately reflect blood volume or fluid > responsiveness. This neglects the value of the whole. For example, > increasing ScvO2 together with CVP in response to fluid administration does > indeed indicate fluid responsiveness. > > 5) All or none compliance with the resuscitation bundle peaks at about 30% > in most of our hospitals. Will adopting more expensive and scarce > technologies such as IVC ultrasound, echo, PPV, esophageal Doppler, or > tissue oxygenation, each with its own problems, improve or degrade our > compliance? Will they really be utilized as continuous or intermittent > monitoring modalities, or will they be one-time measures? Is there > convincing evidence-based proof that they will improve outcome? > > Thanks, > > Ron Elkin MD > California Pacific Medical Center > San Francisco > > > > > > > > On Thu, Dec 8, 2011 at 9:49 PM, Carina Idiesca <[email protected]> wrote: > >> Dear All, >> >> I would like to ask for a feedback regarding an article authored by Paul >> E. Marik which was published in the Annals of Intensive Care 2011 *1*:17. >> The article is entitled " Surviving sepsis:going beyond the guidelines". >> Much to my chagrin, it contained unfavorable reviews of the SSC bundles. >> >> Hoping to hear from you all, >> Carina >> MD. USA >> >> PS >> Since the NICE-SUGAR study, is the majority still using intensive insulin >> therapy drip for hyperglycemia in the ICU patients? Our pharmacist shared >> an article (details & source to follow, apologies) regarding the use of >> insulin drip to treat hyperglycemia as a weak recommendation. >> >> Thanks. >> >> >> >> _______________________________________________ >> Sepsisgroups mailing list >> [email protected] >> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org >> >> >
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