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Báo cáo y học: " Guidance in sepsis management: navigating uncharted water"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Guidance in sepsis management: navigating uncharted waters? | Available online http ccforum.eom content 12 5 428 Letter Guidance in sepsis management navigating uncharted waters Michael C Reade1 Stephen J Warrillow1 John A Myburgh2 and Rinaldo Bellomo1 1 Department of Intensive Care Medicine Austin Hospital University of Melbourne 145 Studley Road Heidelberg Victoria 3084 Australia 2Division of Critical Care and Trauma The George Institute for International Health PO Box M201 Missenden Road Sydney NSW 2050 Australia Corresponding author Professor Rinaldo Bellomo rinaldo.bellomo@austin.org.au Published 10 October 2008 This article is online at http ccforum.com content 12 5 428 2008 BioMed Central Ltd Critical Care 2008 12 428 doi 10.1186 cc7004 See related commentary by Vincent and Marshall http ccforum.com content 12 3 162 A platypus is a duck designed by a committee. Australian aphorism Practice guidelines should be enormously helpful to our patients. We offer another view however to that expressed by authors of the Surviving Sepsis Campaign SSC 1 . Traditionally clinical decisions have been informed by peers but committees such as the SSC seek to drive rather than reflect consensus. Is criticism of this new approach justified Guidelines can influence physicians to act against their better judgement. For example while only 47 of surveyed intensivists believed that central venous pressure should guide resuscitation 86 used it because of the SSC recommendation 2 . Protocols may improve care but what should one do when audited patient outcomes are already better than those achieved by guideline interventions - such as early goal-directed therapy for severe sepsis 3 Guidelines for high-income countries may be inappropriate elsewhere where assigning resources to guideline compliance might preclude other interventions. Such prioritisation is better determined by clinicians in response to local circumstances than by international expert panels. When guidelines become a standard of care equipoise for confirmatory trials can be lost.