Guidelines for severe infections: are they useful?

Abstract

The change bundle approach to performance improvement (guidelines-based) is the key to change in practice. The Surviving Sepsis Campaign/Institute of Healthcare Improvement sepsis change bundles are an excellent example of progress along these lines.

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

“…Although evidence-based recommendations have been published frequently in the medical literature, documentation of impact on patient outcome is limited (338). However, there is growing evidence that protocol implementation associated with education and performance feedback does change clinician behavior and may improve outcomes and reduce costs in severe sepsis (20, 24, 25).…”

The Hemodynamic “Target”: A Visual Tool of Goal-Directed Therapy for Septic Patients

“…5,13 For hemodynamic support, the creation of a multiparametric monitoring tool such as the target diagram has revealed a way to educate and involve the nursing team in this aim. …”

“…3,4 In order to help the physician, authors try to define tools to synthesize evidence for use in bedside practice, helping to reduce variations and uncertainty in practice. 5 Hollenberg et al 6 argue that for hemodynamic management, it is fundamental that clinicians define specific goals and end points, titrate therapies to those end points, and continually evaluate the results of their interventions by monitoring multiple variables of global and regional perfusion.…”

Sepsis and Major Abdominal Surgery Lead to Flaking of the Endothelial Glycocalix

“…Besides antibiotics, there are few therapies proven to improve survival [16]. An integral part of sepsis therapy is the liberal administration of fluids with crystalloid or colloid solutions to maintain the patient's intravascular volume (measured by mean arterial blood pressure or central venous pressure), to counteract the extravasation of fluid due to capillary leakage syndrome.…”