Thanks for your thoughtful comments. As more and more hospitals improve their care with protocols and other approaches, it become harder and harder to show that something new does better.
G On 3/22/14 8:35 PM, "Townsend, Sean, M.D." <[email protected]> wrote: >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, Œusual care¹ 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 ³sepsis protocols² 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] >s.org>" ><[email protected]<mailto:[email protected] >s.org>> >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 don¹t 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 . 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If you have received this >communication in error, please notify the Sender immediately by a "reply >to sender only" message and destroy all electronic or paper copies of the >communication, including any attachments. >_______________________________________________ >Sepsisgroups mailing list >[email protected]<mailto:[email protected] >.org> >http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org >_______________________________________________ >Sepsisgroups mailing list >[email protected]<mailto:[email protected] >.org> >http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
