Hi George, I weighed in a bit last week. SSC is working on our more balanced and formal remarks. I don't think most of us think protocols are dead. In fact, usual care at most places included protocols whether clear from the manuscript of not -- I was a resident at Beth Israel Deaconess and I can tell you the MUST (multiple urgent sepsis therapies) protocol started changing care there as far back as 2002. So, I don't well understand the assertion in the methods that the sites didn't have protocols. The Brigham did as well, and so on.
Here are a repeat of my earlier remarks. More to come from us... The ProCESS results are important because the trial is multi-institutional and somewhat controlled, several issues need to be critically examined in the coming days. These results will be better examined by those less invested in the Campaign than myself and my colleagues. However, some issues to consider include: 1. There is a question of face validity for mortality rates such as reported here. Two accompanying papers in the same issue of the NEJM report severe sepsis mortality rates in the 30% range. 2. Each of these institutions were tertiary care institutions influenced substantially over the last decade by the work of the Surviving Sepsis Campaign. Stated differently, ‘usual care’ has been systematically changed by the SSC over a decade already in terms of early resuscitation through protocols. 3. In all groups, the total % of enrolled patients that had central lines in 6 hours was approximately 60%. If most institutions on this listserv could have 60% central line placement, many of us would be very happy and likely have lower mortality rates. 4. There were 1300 patients excluded from this trial for logistical reasons. Thus, half the patients were excluded. This extraordinarily high rate requires further understanding. 5. 75% of enrolling sites had “sepsis protocols” and usual care occurred in same ED setting as the two protocol-directed arms. I think we have more to learn about protocolized resuscitation for sepsis. In many ways all 3 arms were quantitative resuscitation strategies. The results of ARISE and PROMIS should provide us with further understanding over time. Sean Sean R. Townsend, M.D. Vice President of Quality & Safety California Pacific Medical Center 2330 Clay Street, #301<x-apple-data-detectors://0/0> San Francisco, CA 94115<x-apple-data-detectors://0/0> email [email protected]<mailto:[email protected]> office (415) 600-5770<tel:(415)%20600-5770> fax (415) 600-1541<tel:(415)%20600-1541> On Mar 22, 2014, at 7:14 AM, "Kramer, George C." <[email protected]<mailto:[email protected]>> wrote: I look forward to comments on the NEJM that shows no benefit to EGDT or even use of Sepsis protocols in the ED. Are any of the investigators on the Sepsisgroups.org<http://Sepsisgroups.org> email list? I am sure some of the leaders of the SSC have some opinions. ARE PROTOCOLS DEAD? http://www.nejm.org/doi/full/10.1056/NEJMoa1401602 g From: Mary Draper <[email protected]<mailto:[email protected]>> Date: Thursday, March 20, 2014 4:32 PM To: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Cc: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: Re: [Sepsis Groups] Hypoglycemia Interesting, we have not found hypoglycemia in our severe sepsis patient population. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045<tel:(925)%20674-2045> Cell (925) 451-8792<tel:(925)%20451-8792> Fax (925) 674-2373<tel:(925)%20674-2373> [email protected]<mailto:[email protected]> On Mar 20, 2014, at 12:10 PM, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> wrote: In a recent review of some of our sepsis records, we found a group of patients who had profoundly low blood sugars (11-40). I don’t hear much about hypoglycemia in Sepsis as much as hyperglycemia. We are curious how other hospitals are looking at this and what the plan of care is when this occurs. Is it part of your sepsis bundles to check blood sugars? Only in diabetics? How do you treat and follow up?? Thanks in advance, Susan McKinney, RN Susan McKinney Clinical Quality Coordinator- -Sepsis-VTE Clinical Effectiveness Team [email protected]<mailto:[email protected]> 605-484-7381 Cell 605-755-4428-please note new number ________________________________ Regional Health's mission is to provide and support health care excellence in partnership with the communities we serve. Note: The information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws . If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. 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