Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Copyright policy )Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
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.
- Indiana University – Purdue University Indianapolis United States
- UNIVERSIDADE DE SAO PAULO Brazil
- Centro Hospitalar de Lisboa Central Portugal
- Massachusetts General Hospital United States
- University of Ottawa Canada
vancomycin, analgesic agent; antibiotic agent; anticoagulant agent; antithrombin; bicarbonate; carbapenem; cefepime; ceftriaxone; cephalosporin derivative; cilastatin plus imipenem; ciprofloxacin; colistin; dalteparin; doripenem; drotrecogin; ertapenem; heparin; hypertensive agent; insulin; levofloxacin; low molecular weight heparin; meropenem; neuromuscular blocking agent; penicillin derivative; piperacillin plus tazobactam; procalcitonin; teicoplanin; thrombomodulin; unindexed drug; vancomycin; antiinfective agent, abdominal infection; acute kidney failure; adult respiratory distress syndrome; analgesia; antibiotic therapy; anticoagulant therapy; artificial ventilation; assessment of humans; blood sampling; bronchospasm; cohort analysis; conflict of interest; consensus; electronic medical record; evidence based medicine; fluid resuscitation; funding; Grading of Recommendations Assessment Development and Evaluation system; health care organization; health care policy; health care quality; hemodynamics; high frequency ventilation; high risk patient; human; infection; infection control; infection prevention; insulin treatment; lactic acidemia; meta analysis; pharmacodynamics; pharmacokinetic parameters; point of care testing; positive end expiratory pressure; practice guideline; priority journal; pulmonary artery catheter; purification; randomized controlled trial (topic); renal replacement therapy; resuscitation; Review; risk factor; sedation; sepsis; septic shock; stress ulcer; survival rate; teleconference; thrombosis prevention; venous thromboembolism; fluid therapy; intensive care; intensive care unit; nutritional support; practice guideline; sepsis; Shock, Septic; standards, Anti-Bacterial Agents; Critical Care; Fluid Therapy; Humans; Intensive Care Units; Nutritional Support; Respiration, Artificial; Resuscitation; Sepsis; Shock, Septic; Development and Evaluation criteria; evidence-based medicine; Grading of Recommendations Assessment; guidelines; infection; sepsis; sepsis bundles; sepsis syndrome; septic shock; Surviving Sepsis Campaign, antibiotic agent; anticoagulant agent; antiinfective agent; antithrombin; beta 2 adrenergic receptor stimulating agent; bicarbonate; corticosteroid; creatinine; dobutamine; DOPA; dopamine; epinephrine; erythropoietin; fresh frozen plasma; glucose; heparin; histamine H2 receptor antagonist; hydrocortisone; hypertensive factor; immunoglobulin; low molecular weight heparin; neuromuscular blocking agent; noradrenalin; omega 3 fatty acid; procalcitonin; prokinetic agent; proton pump inhibitor; thrombomodulin; unindexed drug; vasopressin; antiinfective agent; calcitonin; glucose blood level; vasoconstrictor agent, acute kidney failure; adult respiratory distress syndrome; anemia; antibiotic therapy; arterial blood; artery catheter; Article; artificial ventilation; bacteremia; bleeding; capillary blood; clinical trial; conflict of interest; critically ill patient; crystalloid; drug combination; drug contraindication; drug withdrawal; erythrocyte transfusion; evidence based practice; fluid balance; fluid therapy; gastrointestinal hemorrhage; health care quality; heart muscle ischemia; hemodynamics; hemoglobin determination; human; hypoxemia; immune deficiency; lactic acidemia; low drug dose; mortality; mycosis; neutropenia; noninvasive ventilation; oliguria; parenteral nutrition; pharmacokinetics; point of care testing; positive end expiratory pressure; practice guideline; pulmonary artery catheter; pulmonary artery catheterization; pyelonephritis; renal protection; respiratory failure; resuscitation; screening; sepsis; septic shock; stress ulcer; supine position; teleconference; thrombocyte transfusion; thrombosis prevention; treatment duration; treatment response; vascular access; vascular access device; venous thromboembolism; virus infection; blood; consensus development; critical illness; glucose blood level; nutritional assessment; patient care planning; practice guideline; renal replacement therapy; sepsis; Shock, Septic, Anti-Bacterial Agents; Blood Glucose; Calcitonin; Critical Illness; Erythrocyte Transfusion; Fluid Therapy; Humans; Nutrition Assessment; Patient Care Planning; Renal Replacement Therapy; Respiration, Artificial; Sepsis; Shock, Septic; Vasoconstrictor Agents; Evidence-based medicine; Grading of Recommendations Assessment, Development, and Evaluation criteria; Guidelines; Infection; Sepsis; Sepsis bundles; Sepsis syndrome; Septic shock; Surviving Sepsis Campaign, fluid resuscitation, anticoagulant agent, Critical Care and Intensive Care Medicine, sepsis, capillary blood, prokinetic agent, meropenem, Septic shock, antibiotic therapy, consensu, antibiotic agent, colistin, guidelines, Sepsis syndrome, health care organization, beta 2 adrenergic receptor stimulating agent, Nutritional Support, Respiration, low molecular weight heparin, creatinine, clinical trial, Calcitonin/blood, hypertensive factor, anemia, Shock, Septic, and Evaluation criteria, antiinfective agent, Renal Replacement Therapy, antithrombin, Artificial, erythropoietin, dopamine, Infection, corticosteroid, insulin, Evidence-based medicine, proton pump inhibitor, Critical Illness, fresh frozen plasma, drug combination, bicarbonate, omega 3 fatty acid, Guidelines, Development, piperacillin plus tazobactam, Article, cilastatin plus imipenem, critically ill patient, ertapenem, Sepsis, neuromuscular blocking agent, cefepime, unindexed drug, Evidence-based medicine; Grading of Recommendations Assessment, Development, and Evaluation criteria; Guidelines; Infection; Sepsis; Sepsis bundles; Sepsis syndrome; Septic shock; Surviving Sepsis Campaign; Critical Care and Intensive Care Medicine, Humans, hydrocortisone, vasoconstrictor agent, bacteremia, levofloxacin, anticoagulant therapy, funding, dobutamine, cephalosporin derivative, thrombomodulin, Respiration, Artificial, infection, ceftriaxone, Anti-Bacterial Agents/therapeutic use, glucose blood level, immunoglobulin, Septic/diagnosis, Blood Glucose, evidence based medicine, vasopressin, artery catheter, heparin, Grading of Recommendations Assessment, Patient Care Planning, Sepsis bundles, Critical Illness/therapy, histamine H2 receptor antagonist, calcitonin, Vasoconstrictor Agents, glucose, electronic medical record, teicoplanin, Shock, analgesia, artificial ventilation, analgesic agent, drotrecogin, adult respiratory distress syndrome, Anti-Bacterial Agents, assessment of human, Intensive Care Units, bronchospasm, DOPA, blood sampling, sepsis bundles, evidence-based medicine, Erythrocyte Transfusion, procalcitonin, Calcitonin, Critical Care, noradrenalin, conflict of interest, Resuscitation, cohort analysi, abdominal infection, doripenem, Sepsis/diagnosis, carbapenem, dalteparin, ciprofloxacin, acute kidney failure, Anti-Bacterial Agents/administration & dosage, sepsis syndrome, Critical Care/standards, epinephrine, hypertensive agent, Surviving Sepsis Campaign, Vasoconstrictor Agents/therapeutic use, bleeding, penicillin derivative, crystalloid, Nutrition Assessment, septic shock, Fluid Therapy, arterial blood, Grading of Recommendations Assessment Development and Evaluation system
vancomycin, analgesic agent; antibiotic agent; anticoagulant agent; antithrombin; bicarbonate; carbapenem; cefepime; ceftriaxone; cephalosporin derivative; cilastatin plus imipenem; ciprofloxacin; colistin; dalteparin; doripenem; drotrecogin; ertapenem; heparin; hypertensive agent; insulin; levofloxacin; low molecular weight heparin; meropenem; neuromuscular blocking agent; penicillin derivative; piperacillin plus tazobactam; procalcitonin; teicoplanin; thrombomodulin; unindexed drug; vancomycin; antiinfective agent, abdominal infection; acute kidney failure; adult respiratory distress syndrome; analgesia; antibiotic therapy; anticoagulant therapy; artificial ventilation; assessment of humans; blood sampling; bronchospasm; cohort analysis; conflict of interest; consensus; electronic medical record; evidence based medicine; fluid resuscitation; funding; Grading of Recommendations Assessment Development and Evaluation system; health care organization; health care policy; health care quality; hemodynamics; high frequency ventilation; high risk patient; human; infection; infection control; infection prevention; insulin treatment; lactic acidemia; meta analysis; pharmacodynamics; pharmacokinetic parameters; point of care testing; positive end expiratory pressure; practice guideline; priority journal; pulmonary artery catheter; purification; randomized controlled trial (topic); renal replacement therapy; resuscitation; Review; risk factor; sedation; sepsis; septic shock; stress ulcer; survival rate; teleconference; thrombosis prevention; venous thromboembolism; fluid therapy; intensive care; intensive care unit; nutritional support; practice guideline; sepsis; Shock, Septic; standards, Anti-Bacterial Agents; Critical Care; Fluid Therapy; Humans; Intensive Care Units; Nutritional Support; Respiration, Artificial; Resuscitation; Sepsis; Shock, Septic; Development and Evaluation criteria; evidence-based medicine; Grading of Recommendations Assessment; guidelines; infection; sepsis; sepsis bundles; sepsis syndrome; septic shock; Surviving Sepsis Campaign, antibiotic agent; anticoagulant agent; antiinfective agent; antithrombin; beta 2 adrenergic receptor stimulating agent; bicarbonate; corticosteroid; creatinine; dobutamine; DOPA; dopamine; epinephrine; erythropoietin; fresh frozen plasma; glucose; heparin; histamine H2 receptor antagonist; hydrocortisone; hypertensive factor; immunoglobulin; low molecular weight heparin; neuromuscular blocking agent; noradrenalin; omega 3 fatty acid; procalcitonin; prokinetic agent; proton pump inhibitor; thrombomodulin; unindexed drug; vasopressin; antiinfective agent; calcitonin; glucose blood level; vasoconstrictor agent, acute kidney failure; adult respiratory distress syndrome; anemia; antibiotic therapy; arterial blood; artery catheter; Article; artificial ventilation; bacteremia; bleeding; capillary blood; clinical trial; conflict of interest; critically ill patient; crystalloid; drug combination; drug contraindication; drug withdrawal; erythrocyte transfusion; evidence based practice; fluid balance; fluid therapy; gastrointestinal hemorrhage; health care quality; heart muscle ischemia; hemodynamics; hemoglobin determination; human; hypoxemia; immune deficiency; lactic acidemia; low drug dose; mortality; mycosis; neutropenia; noninvasive ventilation; oliguria; parenteral nutrition; pharmacokinetics; point of care testing; positive end expiratory pressure; practice guideline; pulmonary artery catheter; pulmonary artery catheterization; pyelonephritis; renal protection; respiratory failure; resuscitation; screening; sepsis; septic shock; stress ulcer; supine position; teleconference; thrombocyte transfusion; thrombosis prevention; treatment duration; treatment response; vascular access; vascular access device; venous thromboembolism; virus infection; blood; consensus development; critical illness; glucose blood level; nutritional assessment; patient care planning; practice guideline; renal replacement therapy; sepsis; Shock, Septic, Anti-Bacterial Agents; Blood Glucose; Calcitonin; Critical Illness; Erythrocyte Transfusion; Fluid Therapy; Humans; Nutrition Assessment; Patient Care Planning; Renal Replacement Therapy; Respiration, Artificial; Sepsis; Shock, Septic; Vasoconstrictor Agents; Evidence-based medicine; Grading of Recommendations Assessment, Development, and Evaluation criteria; Guidelines; Infection; Sepsis; Sepsis bundles; Sepsis syndrome; Septic shock; Surviving Sepsis Campaign, fluid resuscitation, anticoagulant agent, Critical Care and Intensive Care Medicine, sepsis, capillary blood, prokinetic agent, meropenem, Septic shock, antibiotic therapy, consensu, antibiotic agent, colistin, guidelines, Sepsis syndrome, health care organization, beta 2 adrenergic receptor stimulating agent, Nutritional Support, Respiration, low molecular weight heparin, creatinine, clinical trial, Calcitonin/blood, hypertensive factor, anemia, Shock, Septic, and Evaluation criteria, antiinfective agent, Renal Replacement Therapy, antithrombin, Artificial, erythropoietin, dopamine, Infection, corticosteroid, insulin, Evidence-based medicine, proton pump inhibitor, Critical Illness, fresh frozen plasma, drug combination, bicarbonate, omega 3 fatty acid, Guidelines, Development, piperacillin plus tazobactam, Article, cilastatin plus imipenem, critically ill patient, ertapenem, Sepsis, neuromuscular blocking agent, cefepime, unindexed drug, Evidence-based medicine; Grading of Recommendations Assessment, Development, and Evaluation criteria; Guidelines; Infection; Sepsis; Sepsis bundles; Sepsis syndrome; Septic shock; Surviving Sepsis Campaign; Critical Care and Intensive Care Medicine, Humans, hydrocortisone, vasoconstrictor agent, bacteremia, levofloxacin, anticoagulant therapy, funding, dobutamine, cephalosporin derivative, thrombomodulin, Respiration, Artificial, infection, ceftriaxone, Anti-Bacterial Agents/therapeutic use, glucose blood level, immunoglobulin, Septic/diagnosis, Blood Glucose, evidence based medicine, vasopressin, artery catheter, heparin, Grading of Recommendations Assessment, Patient Care Planning, Sepsis bundles, Critical Illness/therapy, histamine H2 receptor antagonist, calcitonin, Vasoconstrictor Agents, glucose, electronic medical record, teicoplanin, Shock, analgesia, artificial ventilation, analgesic agent, drotrecogin, adult respiratory distress syndrome, Anti-Bacterial Agents, assessment of human, Intensive Care Units, bronchospasm, DOPA, blood sampling, sepsis bundles, evidence-based medicine, Erythrocyte Transfusion, procalcitonin, Calcitonin, Critical Care, noradrenalin, conflict of interest, Resuscitation, cohort analysi, abdominal infection, doripenem, Sepsis/diagnosis, carbapenem, dalteparin, ciprofloxacin, acute kidney failure, Anti-Bacterial Agents/administration & dosage, sepsis syndrome, Critical Care/standards, epinephrine, hypertensive agent, Surviving Sepsis Campaign, Vasoconstrictor Agents/therapeutic use, bleeding, penicillin derivative, crystalloid, Nutrition Assessment, septic shock, Fluid Therapy, arterial blood, Grading of Recommendations Assessment Development and Evaluation system
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