Thanks Jeannine for sending. We did think of Dr. Marik's opinions and respect his body of work and attempt to include as an option to assess volume responsiveness by a means he prefers, the dynamic assessment of volume responsiveness (colloquially known as passive leg raising) as a choice for providers, but he does not appear to be pleased that choices for physicians exist under SEP-1. The recent trials on septic shock affirmed the power of "usual care." Nobody really knows what usual care is, it's whatever the doctor wanted to do. In SEP-1 we presumed usual care included a reassessment of a patient as the responsible thing a provider would do by admitted a patient to the ICU with septic shock. But since nobody know what actually was done, we provided a palette of choices including the most common options from an exam to passive leg raising. In this way, SEP-1 endorses the three largest new trials on septic shock, endorses "usual care." What you can't do in SEP-1 is not reassess a patient. We presume not reassessing patients under those detailed study conditions with study nurses, bedside nurses, 24 hour intensivists in the case of ProCESS, etc. was not a viable choice.
Sean R. Townsend, M.D. Vice President of Quality & Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email [email protected]<mailto:[email protected]> office (415) 600-5770 fax (415) 600-1541
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