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• W3204524443 abstract "We read with interest the article by Yealy et al1Yealy DM, Mohr NM, Shapiro NI, et al. Early care of adults with suspected sepsis in the emergency department and out-of-hospital environment: a consensus- based task force report. Ann Emerg Med. In press.Google Scholar titled “Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report,” and we commend the authors on their generally comprehensive and timely report. While the consensus development process leverages methodological rigor, it is inherently susceptible to rapid obsolescence as the evidence base evolves. A potential consequence is a delay in the dissemination and implementation of high-quality evidence. Notably, the evidence-based recommendations on “Intravenous Fluid and Timing of Vasopressors” acknowledge the role of dynamic fluid responsiveness to initial sepsis resuscitation and describe the different methods used to quantitatively measure whether a patient will respond to the administration of a fluid bolus or passive leg raise by increasing cardiac output, classified as being “fluid responsive” or “fluid nonresponsive.” In this regard, the authors conclude that “although these methods (change in stroke volume or cardiac output in response to passive leg raise) are physiologically rational, clinical outcome data are insufficient at this time to support a recommendation for their use.” This erroneous conclusion is predicated on outdated literature and does not include reference to the Fluid Response Evaluation in Septic Shock (FRESH) study coauthored by several of the task force authors themselves.2Douglas I.S. Alapat P.M. Corl K.A. et al.Fluid response evaluation in sepsis hypotension and shock: a randomized clinical trial.Chest. 2020; 158: 1431-1445Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar FRESH was a prospective, multicenter, randomized controlled trial evaluating resuscitation guided by the dynamic measurement of a 10% or larger increase in stroke volume as a measure of fluid responsiveness in patients with septic shock. The study concluded that physiologically informed fluid and vasopressor resuscitation guided by dynamic assessments resulted in lower net fluid balance and reductions in the risk of progression to sepsis-associated renal and respiratory failure. While underpowered for detecting changes in survival, these outcomes are sufficiently compelling, in our view, to warrant acknowledgment and graded recommendation in the initial resuscitation of adults with sepsis-associated hypotension and shock. Optimally, a consensus task force mechanism and report should serve as a basis for both evidence-based guideline development and research prioritization.3Rodwin B.A. Merchant N.B. From bench to every bedside: improving the adoption of evidence- based practices.South Med J. 2020; 113: 538-540Crossref PubMed Scopus (1) Google Scholar Thus, it would be optimal to develop a more dynamic and continuously updated consensus mechanism that capitalizes on both human expertise and artificial intelligence data mining methods (termed “living guidelines”) to curate, prioritize, and contemporaneously update high-impact consensus recommendations, guidelines, and research priorities.4Seyfang A. Martínez-Salvador B. Serban R. et al.Maintaining Formal Models of Living Guidelines Efficiently.in: Bellazzi R. Abu-Hanna A. Hunter J. Artificial Intelligence in Medicine. Springer-Verlag Berlin Heidelberg, 2007: 441-445Crossref Scopus (15) Google Scholar In Reply to Ivor Douglas Letter to the Editor 2021-1053Annals of Emergency MedicineVol. 78Issue 4PreviewWe thank Douglas et al for their interest in our work. As noted in our manuscript, we used a multidisciplinary and multiorganizational approach to address the opportunities and limits of current guidelines on sepsis care.1 We specifically did not create a comprehensive and graded series of recommendations on early care, seeking instead to identify key concerns in current recommendations and care quality measures. We sought to address current controversies and help inform future guideline development and quality measures that bridge all acute care settings. Full-Text PDF Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force ReportAnnals of Emergency MedicineVol. 78Issue 1PreviewSepsis is a major cause of hospital death in the United States (US)1 and is associated with over 850,000 annual emergency department visits.2 Despite advances in care, patients with serious infection continue to have a high inpatient mortality rate, reaching 20% or more in some settings. This makes sepsis and septic shock one of the highest mortality conditions treated in the ED. Additionally, many survivors never fully recover, and instead, long-term morbidities, chronic critical illness, or post-intensive care syndrome develops in them. Full-Text PDF" @default.
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• W3204524443 title "Dynamic Fluid Response Measures to Guide Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment" @default.
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