Following "Surviving Sepsis" Guidelines Not Always the Best Care By Dr. Philippe Rola First of all, I would like to commend those involved in the Surviving Sepsis Campaign's Guidelines. It is a tremendous endeavour that, without a doubt, has heightened awareness and their growing implementation has and will save many lives. I would, however, also like to point out that guidelines are exactly what the term implies, and not necessarily a gold standard to aspire to and adhere to in religious fashion. The reason this is so is the inherent variability in human physiology and pathology. If, out of 100 patients a treatment would help 10 but harm 1, the numbers and studies would clearly support its broad use. We'd win more than we'd lose. However, as physicians, we treat the one patient in front of us, not the hundred, so I find it difficult to believe that such blind application of a recipe would be the most Hippocratic practice to apply. We know that our patients are widely different, and around the corner is point of care immunology that will tell us, in all likelihood, that even patients we think are similar on the surface will have widely different immune profiles and will respond to treatment differently. There are a few recommendations which, to me, make little physiological sense, particularly in certain circumstances: I don't think it necessary to belabour the point about CVP. As a static measure,