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Rebuttal From Drs Dellinger and TownsendRebuttal From Drs Dellinger and Townsend

R. Phillip Dellinger, MD, FCCP; Sean R. Townsend, MD, FCCP
Author and Funding Information

From the Cooper Medical School of Rowan University (Dr Dellinger); Cooper University Hospital (Dr Dellinger); California Pacific Medical Center (Dr Townsend); and University of California, San Francisco (Dr Townsend).

Correspondence to: R. Phillip Dellinger, MD, FCCP, Cooper Health System, CCM Section-3rd Floor Dorrance, 1 Cooper Plaza, 383 Dorrance, Camden, NJ 08103; e-mail: dellinger-phil@cooperhealth.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Drs Dellinger and Townsend have leadership roles in the Surviving Sepsis Campaign, an organization that espouses the use of a sepsis bundle in the management of severe sepsis.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):378-379. doi:10.1378/chest.13-0847
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Extract

Dr Marik and colleagues1 have overstated their position, attempting to convince us that ventilator-associated pneumonia bundles and sepsis bundles are potentially harmful. Despite several pages of pointing here and there, they never cite a single trial of any sort that demonstrates actual harm from bundled therapies, which is because all such trials reach the opposite conclusion.

With regard to their criticism of the all-or-none principle of bundle care, it has always been espoused by the Surviving Sepsis Campaign (SSC) that not all elements of the sepsis bundle apply to a given patient with severe sepsis; for example, some patients will not qualify for central venous pressure (CVP) and central venous oxygen saturation (Scvo2) measurement, and severity of pathophysiology itself will prevent some goals from being achieved.

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