Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
Rhodes, Andrew MB BS, MD(Res) (Co-chair) 1; Evans, Laura E. MD, MSc, FCCM (Co-chair) 2; Alhazzani, Waleed MD, MSc, FRCPC (methodology chair) 3; Levy, Mitchell M. MD, MCCM 4; Antonelli, Massimo MD 5; Ferrer, Ricard MD, PhD 6; Kumar, Anand MD, FCCM 7; Sevransky, Jonathan E. MD, FCCM 8; Sprung, Charles L. MD, JD, MCCM 9; Nunnally, Mark E. MD, FCCM 2; Rochwerg, Bram MD, MSc (Epi) 3; Rubenfeld, Gordon D. MD (conflict of interest chair) 10; Angus, Derek C. MD, MPH, MCCM 11; Annane, Djillali MD 12; Beale, Richard J. MD, MB BS 13; Bellinghan, Geoffrey J. MRCP 14; Bernard, Gordon R. MD 15; Chiche, Jean-Daniel MD 16; Coopersmith, Craig MD, FACS, FCCM 8; De Backer, Daniel P. MD, PhD 17; French, Craig J. MB BS 18; Fujishima, Seitaro MD 19; Gerlach, Herwig MBA, MD, PhD 20; Hidalgo, Jorge Luis MD, MACP, MCCM 21; Hollenberg, Steven M. MD, FCCM 22; Jones, Alan E. MD 23; Karnad, Dilip R. MD, FACP 24; Kleinpell, Ruth M. PhD, RN-CS, FCCM 25; Koh, Younsuck MD, PhD, FCCM 26; Lisboa, Thiago Costa MD 27; Machado, Flavia R. MD, PhD 28; Marini, John J. MD 29; Marshall, John C. MD, FRCSC 30; Mazuski, John E. MD, PhD, FCCM 31; McIntyre, Lauralyn A. MD, MSc, FRCPC 32; McLean, Anthony S. MB ChB, MD, FRACP, FJFICM 33; Mehta, Sangeeta MD 34; Moreno, Rui P. MD, PhD 35; Myburgh, John MB ChB, MD, PhD, FANZCA, FCICM, FAICD 36; Navalesi, Paolo MD 37; Nishida, Osamu MD, PhD 38; Osborn, Tiffany M. MD, MPH, FCCM 31; Perner, Anders MD 39; Plunkett, Colleen M. 25; Ranieri, Marco MD 40; Schorr, Christa A. MSN, RN, FCCM 22; Seckel, Maureen A. CCRN, CNS, MSN, FCCM 41; Seymour, Christopher W. MD 42; Shieh, Lisa MD, PhD 43; Shukri, Khalid A. MD 44; Simpson, Steven Q. MD 45; Singer, Mervyn MD 46; Thompson, B. Taylor MD 47; Townsend, Sean R. MD 48; Van der Poll, Thomas MD 49; Vincent, Jean-Louis MD, PhD, FCCM 50; Wiersinga, W. Joost MD, PhD 51; Zimmerman, Janice L. MD, MACP, MCCM 52; Dellinger, R. Phillip MD, MCCM 22
Critical Care Medicine.
45(3):486-552, March 2017.
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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.
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