The Guidelines are intended to provide standard guidance for the care of patients by grouping evidence-based interventions into bundles that can be easily used by clinicians to improve patient outcome. The 2008 International guidelines for management of severe sepsis and septic shock is a large and extraordinary update of the literature offered by current leaders in the field. Unfortunately, as a consensus of experts, most of whom expressed their opinions by voting, these guidelines do not always represent the state of the art. Furthermore, they can change if new participants take part in the process. By considering the merits and weaknesses of practice guidelines, we conclude that guidelines cannot replace a physician's judgments, but rather should be a starting point for more robust and proficient scientific evidence.