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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
Intensive Care Med. 2017 Mar; 43(3):304-377.IC

Abstract

OBJECTIVE

To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".

DESIGN

A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development.

METHODS

The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

RESULTS

The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions.

CONCLUSIONS

Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

Authors+Show Affiliations

St. George's Hospital, London, England, UK. andrewrhodes@nhs.net.New York University School of Medicine, New York, NY, USA.McMaster University, Hamilton, ON, Canada.Brown University School of Medicine, Providence, RI, USA.Instituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.Vall d'Hebron University Hospital, Barcelona, Spain.University of Manitoba, Winnipeg, MB, Canada.Emory University Hospital, Atlanta, GA, USA.Hadassah Hebrew University Medical Center, Jerusalem, Israel.New York University School of Medicine, New York, NY, USA.McMaster University, Hamilton, ON, Canada.Sunnybrook Health Sciences Centre, Toronto, ON, Canada.University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA.Hospital Raymond Poincare, Garches, France.Saint Thomas Hospital, London, England, UK.University College London Hospitals, London, England, UK.Vanderbilt University Medical Center, Nashville, TN, USA.Service de Reanimation Medicale, Paris, France.Emory University Hospital, Atlanta, GA, USA.CHIREC Hospitals, Braine L'Alleud, Belgium.Western Hospital, Victoria, Australia.Keio University School of Medicine, Tokyo, Japan.Vivantes-Klinikum Neukölln, Berlin, Germany.Karl Heusner Memorial Hospital, Belize Healthcare Partners, Belize City, Belize.Cooper Health System, Camden, NJ, USA.University of Mississippi Medical Center, Jackson, MS, USA.Jupiter Hospital, Thane, India.Rush University Medical Center, Chicago, IL, USA.ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.Federal University of Sao Paulo, Sao Paulo, Brazil.Regions Hospital, St. Paul, MN, USA.Saint Michael's Hospital, Toronto, ON, Canada.Washington University School of Medicine, St. Louis, MO, USA.Ottawa Hospital, Ottawa, ON, Canada.Nepean Hospital, University of Sydney, Penrith, NSW, Australia.Mount Sinai Hospital, Toronto, ON, Canada.UCINC, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.University of New South Wales, Sydney, NSW, Australia.Università dellla Magna Graecia, Catanzaro, Italy.Fujita Health University School of Medicine, Toyoake, Aich, Japan.Washington University School of Medicine, St. Louis, MO, USA.Rigshospitalet, Copenhagen, Denmark.Rush University Medical Center, Chicago, IL, USA.Università Sapienza, Rome, Italy.Cooper Health System, Camden, NJ, USA.Christiana Care Health Services, Newark, DE, USA.University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.Stanford University School of Medicine, Stanford, CA, USA.Kaust Medical Services, Thuwal, Saudi Arabia.University of Kansas Medical Center, Kansas City, KS, USA.Wolfson Institute of Biomedical Research, London, England, UK.Massachusetts General Hospital, Boston, MA, USA.California Pacific Medical Center, San Francisco, CA, USA.University of Amsterdam, Amsterdam, Netherlands.Erasmé University Hospital, Brussels, Belgium.University of Amsterdam, Amsterdam, Netherlands.Houston Methodist Hospital, Houston, TX, USA.Cooper Health System, Camden, NJ, USA.

Pub Type(s)

Consensus Development Conference
Journal Article
Practice Guideline

Language

eng

PubMed ID

28101605

Citation

Rhodes, Andrew, et al. "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016." Intensive Care Medicine, vol. 43, no. 3, 2017, pp. 304-377.
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-377.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., Rochwerg, B., Rubenfeld, G. D., Angus, D. C., Annane, D., Beale, R. J., Bellinghan, G. J., Bernard, G. R., Chiche, J. D., Coopersmith, C., ... Dellinger, R. P. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 43(3), 304-377. https://doi.org/10.1007/s00134-017-4683-6
Rhodes A, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-377. PubMed PMID: 28101605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. AU - Rhodes,Andrew, AU - Evans,Laura E, AU - Alhazzani,Waleed, AU - Levy,Mitchell M, AU - Antonelli,Massimo, AU - Ferrer,Ricard, AU - Kumar,Anand, AU - Sevransky,Jonathan E, AU - Sprung,Charles L, AU - Nunnally,Mark E, AU - Rochwerg,Bram, AU - Rubenfeld,Gordon D, AU - Angus,Derek C, AU - Annane,Djillali, AU - Beale,Richard J, AU - Bellinghan,Geoffrey J, AU - Bernard,Gordon R, AU - Chiche,Jean-Daniel, AU - Coopersmith,Craig, AU - De Backer,Daniel P, AU - French,Craig J, AU - Fujishima,Seitaro, AU - Gerlach,Herwig, AU - Hidalgo,Jorge Luis, AU - Hollenberg,Steven M, AU - Jones,Alan E, AU - Karnad,Dilip R, AU - Kleinpell,Ruth M, AU - Koh,Younsuk, AU - Lisboa,Thiago Costa, AU - Machado,Flavia R, AU - Marini,John J, AU - Marshall,John C, AU - Mazuski,John E, AU - McIntyre,Lauralyn A, AU - McLean,Anthony S, AU - Mehta,Sangeeta, AU - Moreno,Rui P, AU - Myburgh,John, AU - Navalesi,Paolo, AU - Nishida,Osamu, AU - Osborn,Tiffany M, AU - Perner,Anders, AU - Plunkett,Colleen M, AU - Ranieri,Marco, AU - Schorr,Christa A, AU - Seckel,Maureen A, AU - Seymour,Christopher W, AU - Shieh,Lisa, AU - Shukri,Khalid A, AU - Simpson,Steven Q, AU - Singer,Mervyn, AU - Thompson,B Taylor, AU - Townsend,Sean R, AU - Van der Poll,Thomas, AU - Vincent,Jean-Louis, AU - Wiersinga,W Joost, AU - Zimmerman,Janice L, AU - Dellinger,R Phillip, Y1 - 2017/01/18/ PY - 2017/01/02/received PY - 2017/01/06/accepted PY - 2017/1/20/pubmed PY - 2017/7/22/medline PY - 2017/1/20/entrez KW - Evidence-based medicine KW - Grading of Recommendations Assessment, Development, and Evaluation criteria KW - Guidelines KW - Infection KW - Sepsis KW - Sepsis bundles KW - Sepsis syndrome KW - Septic shock KW - Surviving Sepsis Campaign SP - 304 EP - 377 JF - Intensive care medicine JO - Intensive Care Med VL - 43 IS - 3 N2 - OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/28101605/full_citation L2 - https://dx.doi.org/10.1007/s00134-017-4683-6 DB - PRIME DP - Unbound Medicine ER -