Sepsis: personalization v protocolization?
Abstract The founding tenet of evidence-based medicine is to combine best evidence with clinical expertise. As David Sackett opined ‘Without clinical expertise, practice risks becoming tyrannised by evidence’. Rigid protocols and mandates, based on an inconclusive and low-level evidence base, cannot...
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-019-2398-5 |
| _version_ | 1818610837563113472 |
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| author | Mervyn Singer |
| author_facet | Mervyn Singer |
| author_sort | Mervyn Singer |
| collection | DOAJ |
| description | Abstract The founding tenet of evidence-based medicine is to combine best evidence with clinical expertise. As David Sackett opined ‘Without clinical expertise, practice risks becoming tyrannised by evidence’. Rigid protocols and mandates, based on an inconclusive and low-level evidence base, cannot suit the physiological, biochemical and biological heterogeneity displayed by the individual septic patient. Indeed, clear proof of outcome benefit through adoption of an inflexible management approach is lacking and will certainly be detrimental to some. Therapy thus needs to be tailored to meet the individual patient’s needs. The same principle should be applied to clinical trials; the continued disappointments of multiple investigational strategies trialled over three decades, despite (often) a sound biological rationale, suggest a repeated methodological failure that does not account for the marked heterogeneity within the septic patient’s biological phenotype and thus marked variation in their host response. The increasing availability of rapid point-of-care diagnostics and theranostics should facilitate better patient selection and titrated optimization of the therapeutic intervention. |
| first_indexed | 2024-12-16T15:20:47Z |
| format | Article |
| id | doaj.art-de1bcef8e6574d11941655cc42e8d734 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-16T15:20:47Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-de1bcef8e6574d11941655cc42e8d7342022-12-21T22:26:39ZengBMCCritical Care1364-85352019-06-0123S11610.1186/s13054-019-2398-5Sepsis: personalization v protocolization?Mervyn Singer0Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College LondonAbstract The founding tenet of evidence-based medicine is to combine best evidence with clinical expertise. As David Sackett opined ‘Without clinical expertise, practice risks becoming tyrannised by evidence’. Rigid protocols and mandates, based on an inconclusive and low-level evidence base, cannot suit the physiological, biochemical and biological heterogeneity displayed by the individual septic patient. Indeed, clear proof of outcome benefit through adoption of an inflexible management approach is lacking and will certainly be detrimental to some. Therapy thus needs to be tailored to meet the individual patient’s needs. The same principle should be applied to clinical trials; the continued disappointments of multiple investigational strategies trialled over three decades, despite (often) a sound biological rationale, suggest a repeated methodological failure that does not account for the marked heterogeneity within the septic patient’s biological phenotype and thus marked variation in their host response. The increasing availability of rapid point-of-care diagnostics and theranostics should facilitate better patient selection and titrated optimization of the therapeutic intervention.http://link.springer.com/article/10.1186/s13054-019-2398-5SepsisProtocolizationPersonalizationOutcomesEvidence-based medicineBiomarkers |
| spellingShingle | Mervyn Singer Sepsis: personalization v protocolization? Critical Care Sepsis Protocolization Personalization Outcomes Evidence-based medicine Biomarkers |
| title | Sepsis: personalization v protocolization? |
| title_full | Sepsis: personalization v protocolization? |
| title_fullStr | Sepsis: personalization v protocolization? |
| title_full_unstemmed | Sepsis: personalization v protocolization? |
| title_short | Sepsis: personalization v protocolization? |
| title_sort | sepsis personalization v protocolization |
| topic | Sepsis Protocolization Personalization Outcomes Evidence-based medicine Biomarkers |
| url | http://link.springer.com/article/10.1186/s13054-019-2398-5 |
| work_keys_str_mv | AT mervynsinger sepsispersonalizationvprotocolization |