In a recent study from Mayo Clinic, Kelm and colleagues demonstrated that the SSC approach to fluid resuscitation results in fluid overload in 67% of patients with fluid overload being an independent predictor of death with an odds ratio 1.92 (1.16-3.22). A recent study from Professor Jean-Louis Vincent’s ICU (a founding member of the SSC) demonstrated that a large positive fluid balance starting on ICU day two was an independent predictor of death. In the largest study to date, we evaluated day 1 fluid intake (from all sources) in a representative sample of 23 513 patients with severe sepsis and septic shock in the USA. In this analysis we demonstrated that American clinicians administer far less fluid than recommended by the SSC, that over-resuscitation ( 5 liters) significantly increases the risk of death while under-resuscitation was associated with a small but statistically significant survival advantage.
It is remarkable that the Federal Government has mandated that physicians use a therapeutic intervention that is scientifically unproven; this is unprecedented in the history of medicine.[3,4] Both the Federal Government and the authors of the SSC decree there are NO EXCEPTIONS to this rule; astonishingly, they mandate that patients with pneumonia or Acute Lung Injury be intubated so that they can receive the potentially harmful 30ml/kg fluid bolus . this can only be described as reckless and medical malpractice (see Trial Verdicts below).It is critical to stress that the SSC recommendation and the SEP-1 mandate are devoid of any scientific evidence, indeed, a strong body of scientific evidence suggests that such an approach may be harmful.Furthermore, living in a country which values the freedom of speech and the freedom to tell the truth, this letter will be published in its entirety on the Internet.Yours Sincerely, Paul Marik, MD===A Youtube Lecture Paul Linked to on EGDT===From: Marik, Paul E.