Comment on “Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008” by Dellinger et al.
2008; Springer Science+Business Media; Volume: 34; Issue: 6 Linguagem: Inglês
10.1007/s00134-008-1089-5
ISSN1432-1238
Autores Tópico(s)Intensive Care Unit Cognitive Disorders
ResumoWe read with interest the recent revision of the Surviving Sepsis Campaign (SSC) guidelines by Dellinger et al. [1].The use of the GRADE system to classify the strength of the recommendations has certainly improved the guidelines.However, we regret that not all guidelines were adjusted according to the current literature.First of all, the absence of a recommendation regarding selective digestive tract decontamination (SDD) is striking.The guidelines group was evenly split, with equal numbers weakly in favor and against recommending the use of SDD.This is remarkable, since SDD is one of the best ever evaluated therapies in intensive care medicine, with more than 50 randomized controlled trials and 10 meta-analyses showing that SDD reduces pneumonia by 65% and mortality by 22% [2].The authors gave several reasons why they chose not to recommend SDD in their guidelines.They argue that no studies regarding SDD specifically focused on septic patients.However, several other guidelines based on general ICU populations (i.e., stress ulcer prophylaxis, deep vein thrombosis prophylaxis, glucose
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