Critical Care Scenarios Lightning rounds 64: The new Surviving Sepsis guidelines with Hallie Prescott
Mar 30, 2026
Hallie Prescott, pulmonary and critical care physician and guideline co-chair, walks through the new Surviving Sepsis guideline update. She highlights changes like pre-hospital antibiotic criteria, limits on anaerobic coverage, blood pressure and fluid guidance, selective digestive decontamination, and how recommendations were prioritized and graded. Short, practical discussion on application across resource settings.
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Anaerobic Coverage Causes Microbiome Harm Linked To Outcomes
- Anti-anaerobic antibiotics can alter gut microbiome and associate with worse longer-term outcomes like 90-day mortality.
- Prescott notes collateral damage as a key reason to favor narrower-spectrum choices when clinically safe.
Selective Digestive Decontamination Use In Ventilated Patients
- Selective digestive decontamination (SDD) gives topical, oral, and IV narrow-spectrum agents to ventilated ICU patients to prevent hospital-acquired infections.
- Prescott notes SDD is well-studied, used more in Europe, and rarely in the U.S., but trial data justified a recommendation.
How Surviving Sepsis Guidelines Are Built
- Guideline process uses prioritized PICO questions, patient/family input, librarian-led searches, and pre-specified outcomes to avoid cherry-picking.
- Evidence synthesis then feeds an evidence-to-decision framework weighing benefits, harms, cost, equity, feasibility, and acceptability.