Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock
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To develop management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis.
The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations built upon a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along 5 levels to create recommendation grades from A–E, with A being the highest grade. Pediatric considerations were provided to contrast adult and pediatric management.
Participants included 44 critical care and infectious disease experts representing 11 international organizations.
A total of 46 recommendations plus pediatric management considerations.
Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient. The impact of these guidelines will be formally tested and guidelines updated annually, and even more rapidly when some important new knowledge becomes available.
KeywordsSepsis Severe sepsis Septic shock Sepsis syndrome Infection Guidelines Evidence-based medicine Surviving Sepsis Campaign
Founding of the Surviving Sepsis Campaign. The ESICM, SCCM and International Sepsis Forum have established the Surviving Sepsis Campaign with the aim of improving the care of septic patients. The first phase of the Campaign was built around the Barcelona ESICM congress and included the initial Barcelona Declaration, a media campaign that identified sepsis as a killer and the need to make progress in public awareness and to reduce mortality, and two surveys performed among physicians. The cost of phase I was approximately EUR 553,227, and was supported by unrestricted educational grants from Eli Lilly (94%), Edwards (3%) and Baxter (3%). Producing the present guidelines document was the phase II of the Campaign. For this process, the sponsor companies have been entirely separated from the process by which the guidelines were developed by the many contributors, whose conflicts of interest have been collected in accordance with SCCM guidance (see document). The costs for this phase included mainly the costs of the meeting, teleconference and website update, amounted to approximately EUR 125,006, and were beared by unrestricted educational grants from Eli Lilly (90%) and Edwards (10%). Most of the expense for this effort has been time by the committee who received no reimbursement.
- 4.Sprung CL, Bernard GR, Dellinger RP (2001) Introduction. Intensive Care Med 27 [Suppl] :S1-S2Google Scholar
- 9.McCabe WR, Jackson GG (1962) Gram negative bacteremia. Arch Intern Med 110:92–100Google Scholar
- 14.Ali MZ, Goetz MB (1997) A meta-analysis of the relative efficacy and toxicity of single daily dosing versus multiple daily dosing of aminoglycosides. Clin Infec Dis 24:796–809Google Scholar
- 15.Amsden GW, Ballow CH, Bertino JS (2000) Pharmacokinetics and pharmacodynamcis of anti-infective agents. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases. Churchill Livingstone, Philadelphia, pp 253–261Google Scholar
- 16.Hyatt JM, McKinnon PS, Zimmer GS, Schentag JJ (1995) The importance of pharmacokinetic/pharmacodynamic surrogate markers to outcomes. Focus on antibacterial agents. Clin Pharmacokinet 28:143–160Google Scholar
- 20.Centers for Disease Control and Prevention (2002) Guidelines for the prevention of intravascular catheter-related infections. MMWR Morb Mortal Wkly Rep 51:1–29Google Scholar
- 29.Martin C, Viviand X, Leone M, Thirion X (2000) Effect of norepinephrine on the outcome of septic shock. Crit Care Med 28:2758–2765Google Scholar
- 32.Kellum J, Decker J (2003) Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med 29:1526–1531Google Scholar
- 49.The Veterans Administration Systemic Sepsis Cooperative Study Group (1987) Effect on high-dose glucocorticoid therapy on mortality in patients with clinical signs of sepsis. N Engl J Med 317:659–665Google Scholar
- 57.Report of the Working Group (1997) Guidelines for red blood cell and plasma transfusion for adults and children. CMAJ 156 [Suppl]:S1–24Google Scholar
- 65.Eichacker PQ, Gerstenberger EP, Banks SM, Cui X, Natanson C (2002) Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med 166:1510–1514Google Scholar
- 84.Giostra E, Magistris MR, Pizzolato G, Cox J, Chevrolet JC (1994) Neuromuscular disorder in intensive care unit patients treated with pancuronium bromide. Occurrence in a cluster group of seven patients and two sporadic cases, with electrophysiologic and histologic examination. Chest 106:210–220PubMedGoogle Scholar
- 88.Meyer KC, Prielipp RC, Grossman JE, Coursin DB (1994) Prolonged weakness after infusion of atracurium in two intensive care unit patients. Anesth Analg 78:772–774Google Scholar
- 91.Brandom BW, Yellon FF, Lloyd ME et al. (1997) Recovery from doxacurium infusion administered to produce immobility for more than four days in pediatric patients in the intensive care unit. Anesth Analg 84:307–314Google Scholar
- 92.Rudis MI, Sikora CA, Angus E, Peterson E, Popovich J Jr, Hyzy R, Zarowitz BJ (1997) A prospective, randomized, controlled evaluation of peripheral nerve stimulation versus standard clinical dosing of neuromuscular blocking agents in critically ill patients. Crit Care Med 25:575–583Google Scholar
- 97.Klein S, Kinney J, Jeejeebhoy K, Alpers D, Hellerstein M, Murray M, Twomey P (1997) Nutrition support in clinical practice: review of published data and recommendations for future research directions. A summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. Am J Clin Nutr 66:683–706PubMedGoogle Scholar
- 105.Borrero E, Bank S, Margolis I, Schulman ND, Chardavoyne R (1985) Comparison of antacid and sucralfate in the prevention of gastrointestinal bleeding in patients who are critically ill. Am J Med 79:62–64Google Scholar
- 106.Bresalier RS, Grendell JH, Cello JP, Meyer AA (1987) Sucralfate versus titrated antacid for the prevention of acute stress-related gastrointestinal hemorrhage in critically ill patients. Am J Med 83:110–116Google Scholar
- 117.Barton P, Garcia J, Kouatli A, Kitchen L, Zorka A, Lindsay C, Lawless S, Giroir B (1996) Hemodynamic effects of i.v. milrinone lactate in pediatric patients with septic shock. A prospective, double-blinded, randomized, placebo-controlled, interventional study. Chest 109:1302–1312PubMedGoogle Scholar
- 121.Carcillo JA, Fields AI, American College of Critical Care Medicine Task Force Committee Members (2002) Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 30:1365–1378Google Scholar
- 122.De Kleijn ED, Joosten KF, Van Rijn B, Westerterp M, De Groot R, Hokken-Koelega AC, Hazelzet JA (2002) Low serum cortisol in combination with high adrenocorticotrophic hormone concentrations are associated with poor outcome in children with severe meningococcal disease. Pediatr Infect Dis J 21:330–336CrossRefPubMedGoogle Scholar
- 127.Kleijn ED de, Groot R de, Hack CE, Mulder PG, Engl W, Moritz B, Joosten KF, Hazelzet JA (2003) Activation of protein C following infusion of protein C concentrate in children with severe meningococcal sepsis and purpura fulminans: a randomized, double-blinded, placebo-controlled, dose-finding study. Crit Care Med 31:1839–1847CrossRefPubMedGoogle Scholar
- 132.Alejandria MM, Lansang MA, Dans LF, Mantaring JB (2002) Intravenous immunoglobulin for treating sepsis and septic shock. Cochrane Database Syst Rev (1):CD001090Google Scholar