This is surgery. I see rounds. My name is Dr. Jeffrey Guy. We're picking up on a series on reviewing the surviving sepsis guidelines.

If you're picking up, this is the first podcast, Surviving Sepsis Campaign, International Guidelines for Management of Severe Sepsis and Septic Shock 2008.

This was revision of the 2004 guidelines, and this was published in the Journal of

Intensive Care of Medicine, as well as the Society of Critical Care Medicine's journal Critical

Care Medicine. And this was published back in January, volume 36, number one, in 2008.

The first part of the podcast that we've already pushed out, deal with some of the initial

objectives to obtain in the first couple of hours, namely source control, obtaining cultures,

IV antibiotics.

And now we're going to pick up where we left off, and that's with fluid therapy.

And it's important to mention of the guidelines were not brought down carved in stone from a mountain.

This is the current best evidence, and the body of knowledge and critical care of medicine changes at a rapid rate such that what is a guideline today or best evidence today may be antiquated in just a very short period of time

of say 12 or 24 months. It is also important that this is a consensus statement, which means that

the thought leaders in critical care medicine regards to sepsis put together what they thought

felt was the best document, but certainly there was not universal agreement. There has been some editorials, some of them rather scathing, that have criticized the surviving

sepsis campaign.

What's important to point out, though, is this is the best shot that we have or the best attempt

that anyone really, in my opinion, has done to try to collectively bring together the best practices, the best

evidence of what we do for the multifactorial problems that we encounter when we see a septic

patient. So let's talk about fluid therapy. And the guidelines in regards to fluid therapy are not specific as to

whether we should be using crystalloid or colloid. In fact, they recommend fluid or cessation

with either natural or artificial colloids, such as things as Hespan or abumin or crystalloids,

because there is no evidence-based support for either type of one fluid over another,

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