In this AVF Podcast: ICU Tips & Tricks episode, Professor Levy discusses selected points in the recent 2021 Surviving Sepsis Campaign (SSC) guidelines that we thought were potentially more controversial in clinical practice. Professor Levy is a founding member of the SSC and Co-Chair of its Steering Committee, Past President of the Society of Critical Care Medicine (SCCM), Professor of Medicine and Division Chief of Pulmonary and Critical Care Medicine at Alpert Medical School of Brown University, and Medical Director of the Medical Intensive Care Unit (MICU) at Rhode Island Hospital.

Issues discussed in this interview:

• Appropriate use and timing of antifungals 
• Fluid resuscitation: volumes and fluid types
• Bicarbonate use 
• Kidney replacement therapy
• Norepinephrine dosing and vasopressin use
• Top unanswered questions for the next SSC Campaign guidelines
• Importance of evidence-based medicine

Work cited: 

1. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021;49:e1063-e143.
   
   
2. Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 2015;372:1301-11.
   
   
3. ProCess Investigators, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med 2014;370:1683-93.
   
   
4. ARISE Investigators, ANZICS Clinical Trials Group, Peake SL, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014;371:1496-506.
   
   
5. Semler MW, Self WH, Wanderer JP, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med 2018;378:829-39.
   
   
6. Levy MM. An evidence-based evaluation of the use of sodium bicarbonate during cardiopulmonary resuscitation. Crit Care Clin 1998;14:457-83.
   
   
7. von Planta M, Weil MH, Gazmuri RJ, Bisera J, Rackow EC. Myocardial acidosis associated with CO2 production during cardiac arrest and resuscitation. Circulation 1989;80:684-92.
   
   
8. Jaber S, Paugam C, Futier E, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet 2018;392:31-40.
   
   
9. Gordon AC, Mason AJ, Thirunavukkarasu N, et al. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA 2016;316:509-18.
   
   
10. Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008;358:877-87.