04597nas a2200937 4500000000100000008004100001653001100042653002500053653001800078653001800096653001100114653002600125653002400151653002800175653001800203653001800221100001800239700001400257700001800271700001600289700001800305700001800323700001900341700002100360700001600381700001800397700002200415700001800437700001600455700002300471700001900494700001800513700001800531700002100549700002000570700001800590700002400608700001900632700002300651700002200674700002100696700001700717700002200734700001900756700001800775700002200793700001500815700001700830700001900847700001700866700001800883700001600901700001700917700002200934700001900956700001900975700001500994700001901009700001801028700001901046700002101065700001801086700001901104700001901123700002401142700001501166700001801181700001901199700002201218700001801240700002401258700002301282700002201305700002101327700002401348245010501372300001201477490000701489520214901496022001403645 2017 d 10 aHumans 10 aIntensive Care Units 10 aCritical Care 10 aFluid Therapy 10 aSepsis 10 aAnti-Bacterial Agents 10 aNutritional Support 10 aRespiration, Artificial 10 aResuscitation 10 aShock, Septic 1 aRhodes Andrew 1 aMyburgh J 1 aPerner Anders 1 aAngus Derek 1 aMarshall John 1 aSinger Mervyn 1 aMachado Flavia 1 aAlhazzani Waleed 1 aEvans Laura 1 aLevy Mitchell 1 aAntonelli Massimo 1 aFerrer Ricard 1 aKumar Anand 1 aSevransky Jonathan 1 aSprung Charles 1 aNunnally Mark 1 aRochwerg Bram 1 aRubenfeld Gordon 1 aAnnane Djillali 1 aBeale Richard 1 aBellinghan Geoffrey 1 aBernard Gordon 1 aChiche Jean-Daniel 1 aCoopersmith Craig 1 aDe Backer Daniel 1 aFrench Craig 1 aFujishima Seitaro 1 aGerlach Herwig 1 aHidalgo Jorge 1 aHollenberg Steven 1 aJones Alan 1 aKarnad Dilip 1 aKleinpell Ruth 1 aKoh Younsuck 1 aLisboa Thiago 1 aMarini John 1 aMazuski John 1 aMcIntyre Lauralyn 1 aMcLean Anthony 1 aMehta Sangeeta 1 aMoreno Rui 1 aNavalesi Paolo 1 aNishida Osamu 1 aOsborn Tiffany 1 aPlunkett Colleen 1 aRanieri Marco 1 aSchorr Christa 1 aSeckel Maureen 1 aSeymour Christopher 1 aShieh Lisa 1 aShukri Khalid 1 aSimpson Steven 1 aB Thompson Taylor 1 aTownsend Sean 1 aVan der Poll Thomas 1 aVincent Jean-Louis 1 aW Wiersinga Joost 1 aZimmerman Janice 1 aR Dellinger Phillip 00 aSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. a486-552 0 v45 3 a
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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