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Intensive Care Med. 2017 Mar;43(3):304-377. doi: 10.1007/s00134-017-4683-6. Epub 2017 Jan 18.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

Author information

1
St. George's Hospital, London, England, UK. andrewrhodes@nhs.net.
2
New York University School of Medicine, New York, NY, USA.
3
McMaster University, Hamilton, ON, Canada.
4
Brown University School of Medicine, Providence, RI, USA.
5
Instituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.
6
Vall d'Hebron University Hospital, Barcelona, Spain.
7
University of Manitoba, Winnipeg, MB, Canada.
8
Emory University Hospital, Atlanta, GA, USA.
9
Hadassah Hebrew University Medical Center, Jerusalem, Israel.
10
Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
11
University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA.
12
Hospital Raymond Poincare, Garches, France.
13
Saint Thomas Hospital, London, England, UK.
14
University College London Hospitals, London, England, UK.
15
Vanderbilt University Medical Center, Nashville, TN, USA.
16
Service de Reanimation Medicale, Paris, France.
17
CHIREC Hospitals, Braine L'Alleud, Belgium.
18
Western Hospital, Victoria, Australia.
19
Keio University School of Medicine, Tokyo, Japan.
20
Vivantes-Klinikum Neukölln, Berlin, Germany.
21
Karl Heusner Memorial Hospital, Belize Healthcare Partners, Belize City, Belize.
22
Cooper Health System, Camden, NJ, USA.
23
University of Mississippi Medical Center, Jackson, MS, USA.
24
Jupiter Hospital, Thane, India.
25
Rush University Medical Center, Chicago, IL, USA.
26
ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
27
Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
28
Federal University of Sao Paulo, Sao Paulo, Brazil.
29
Regions Hospital, St. Paul, MN, USA.
30
Saint Michael's Hospital, Toronto, ON, Canada.
31
Washington University School of Medicine, St. Louis, MO, USA.
32
Ottawa Hospital, Ottawa, ON, Canada.
33
Nepean Hospital, University of Sydney, Penrith, NSW, Australia.
34
Mount Sinai Hospital, Toronto, ON, Canada.
35
UCINC, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
36
University of New South Wales, Sydney, NSW, Australia.
37
Università dellla Magna Graecia, Catanzaro, Italy.
38
Fujita Health University School of Medicine, Toyoake, Aich, Japan.
39
Rigshospitalet, Copenhagen, Denmark.
40
Università Sapienza, Rome, Italy.
41
Christiana Care Health Services, Newark, DE, USA.
42
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
43
Stanford University School of Medicine, Stanford, CA, USA.
44
Kaust Medical Services, Thuwal, Saudi Arabia.
45
University of Kansas Medical Center, Kansas City, KS, USA.
46
Wolfson Institute of Biomedical Research, London, England, UK.
47
Massachusetts General Hospital, Boston, MA, USA.
48
California Pacific Medical Center, San Francisco, CA, USA.
49
University of Amsterdam, Amsterdam, Netherlands.
50
Erasmé University Hospital, Brussels, Belgium.
51
Houston Methodist Hospital, Houston, TX, USA.

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.

KEYWORDS:

Evidence-based medicine; Grading of Recommendations Assessment, Development, and Evaluation criteria; Guidelines; Infection; Sepsis; Sepsis bundles; Sepsis syndrome; Septic shock; Surviving Sepsis Campaign

PMID:
28101605
DOI:
10.1007/s00134-017-4683-6
[Indexed for MEDLINE]

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