Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008
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Sir: The process of converting scientific evidence into clinical guidelines involves making judgments. Few judgments are absolute – there is usually a penumbra of uncertainty around the decision, and the decision itself will be influenced by factors which may not be answered by current evidence. We used a voting process to identify the point of consensus and the extent of uncertainty for those elements of the guidelines for which there was no unanimity. These included selective digestive tract decontamination (SDD), steroids, glucose control, and activated protein C, among others.
Drs. Spoelstra and Girbes correctly draw attention to the divergence between the scientific literature in favor of SDD and the absence of a recommendation by the guidelines group. However, they describe this as bias, and we would not use this term. The voting process demonstrated the presence either of maximal uncertainty (from a group perspective), or of polarized views, one weakly opposed and the other...
KeywordsCimetidine Ranitidine Survive Sepsis Campaign Stress Ulcer Prophylaxis Vote Process
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