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Intensive Care Med. 2020 Feb;46(Suppl 1):10-67. doi: 10.1007/s00134-019-05878-6.

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children.

Author information

1
Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. WeissS@email.chop.edu.
2
Great Ormond Street Hospital for Children, London, UK.
3
Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
4
Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada.
5
Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
6
C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
7
St. Mary's Hospital, London, UK.
8
Paediatric Critical Care Research Group, The University of Queensland and Queensland Children's Hospital, Brisbane, QLD, Australia.
9
Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa.
10
Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
11
University of Liverpool, Liverpool, UK.
12
Connecticut Children's Medical Center, Hartford, CT, USA.
13
Duke Children's, Durham, NC, USA.
14
St. Christopher's Hospital for Children, Philadelphia, PA, USA.
15
Texas Children's Hospital, Houston, TX, USA.
16
Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.
17
Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay University, Paris, France.
18
King's College Hospital, London, UK.
19
University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
20
The Latin America Sepsis Institute, São Paulo, Brazil.
21
Nationwide Children's Hospital, Columbus, OH, USA.
22
Rady Children's Hospital, San Diego, CA, USA.
23
Centre Hospitalier Universitaire de Lyon, Lyon, France.
24
Erasmus University Medical Center, Rotterdam, The Netherlands.
25
All India Institute of Medical Sciences, New Delhi, India.
26
Children's Hospital of Richmond at VCU, Richmond, VA, USA.
27
Beatrix Children's Hospital, Groningen, The Netherlands.
28
Radboud University Medical Centre, Nijmegen, The Netherlands.
29
National University Health System, Singapore, Singapore.
30
Royal Children's Hospital, Melbourne, VIC, Australia.
31
Department of Anesthesiology, Critical Care and Pain, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
32
Rigshospitalet Hospital, Copenhagen, Denmark.
33
Children's Hospital of Los Angeles, Los Angeles, CA, USA.
34
Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
35
New York University Langone Medical Center, New York, NY, USA.
36
Stony Brook University, Stony Brook, NY, USA.
37
Advocate Children's Hospital, Park Ridge, IL, USA.
38
Apollo Hospitals, Chennai, India.
39
Johns Hopkins Children's Center, Baltimore, MD, USA.
40
Children's Hospital Colorado, Aurora, CO, USA.
41
University of the West of England, Bristol, UK.
42
College of Nursing, University of Iowa, Iowa City, IA, USA.
43
St. Jude Children's Research Hospital, Memphis, TN, USA.
44
Cincinnati Children's Hospital, Cincinnati, OH, USA.
45
Seattle Children's Hospital, Seattle, WA, USA.
46
British Columbia Children's Hospital, Vancouver, BC, Canada.
47
Institute of Integrative Biology of the Cell-CNRS, CEA, Univ Paris Sud, Gif-Sur-Yvette, France.

Abstract

OBJECTIVES:

To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.

DESIGN:

A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process.

METHODS:

The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate.

RESULTS:

The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified.

CONCLUSIONS:

A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.

KEYWORDS:

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

PMID:
32030529
DOI:
10.1007/s00134-019-05878-6

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