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Rebuttal From Dr Marik et alRebuttal From Dr Marik et al

Paul E. Marik, MD; Karthik Raghunathan, MD, MPH; Joshua Bloomstone, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Marik), Eastern Virginia Medical School; Department of Anesthesiology (Dr Raghunathan), Duke University Medical Center; Durham VA Medical Center (Dr Raghunathan); and Department of Anesthesiology and Perioperative Medicine (Dr Bloomstone), Banner Thunderbird Medical Center.

Correspondence to: Paul E. Marik, MD, FCCP, Eastern Virginia Medical School, 825 Fairfax Ave, Ste 410, Norfolk, VA 23507; e-mail: marikpe@evms.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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):379-380. doi:10.1378/chest.13-0849
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Drs Dellinger and Townsend’s1 suggestion that bundles are always evolving is a key reason why bundles should not be universally mandated. Mechanisms invoked by bundles to produce benefits may also produce harm. Until the US Food and Drug Administration’s suspension, several years of organized advocacy accelerated diffusion of Xigris (Eli Lilly and Company) therapy in nonselected populations. Systematic promotion of evidence illustrates the power of bundles to magnify ineffective therapies. Strategies like the catheter-related bloodstream infection prevention bundle may work because of unique contextual factors at play at institutional, national, or specialty-specific levels.2 It is not clear that such checklist bundles can be transplanted without insight into the host culture.3

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