Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Andrew Rhodes; Laura E Evans; Waleed Alhazzani; Mitchell M Levy; Massimo Antonelli; Ricard Ferrer; Anand Kumar; Jonathan E Sevransky; Charles L Sprung; Mark E Nunnally; Bram Rochwerg; Gordon D Rubenfeld; Derek C Angus; Djillali Annane; Richard J Beale; Geoffrey J Bellinghan; Gordon R Bernard; Jean-Daniel Chiche; Craig Coopersmith; Daniel P De Backer; Craig J French; Seitaro Fujishima; Herwig Gerlach; Jorge Luis Hidalgo; Steven M Hollenberg; Alan E Jones; Dilip R Karnad; Ruth M Kleinpell; Younsuck Koh; Thiago Costa Lisboa; Flavia R Machado; John J Marini; John C Marshall; John E Mazuski; Lauralyn A McIntyre; Anthony S McLean; Sangeeta Mehta; Rui P Moreno; John Myburgh; Paolo Navalesi; Osamu Nishida; Tiffany M Osborn; Anders Perner; Colleen M Plunkett; Marco Ranieri; Christa A Schorr; Maureen A Seckel; Christopher W Seymour; Lisa Shieh; Khalid A Shukri; Steven Q Simpson; Mervyn Singer; Taylor Thompson; Sean R Townsend; Thomas Van der Poll; Jean‑Louis Vincent; W Joost Wiersinga; Janice L Zimmerman; R Phillip Dellinger

doi:10.1097/CCM.0000000000002255

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Andrew Rhodes, Laura E Evans, Waleed Alhazzani, Mitchell M Levy, Massimo Antonelli, Ricard Ferrer, Anand Kumar, Jonathan E Sevransky, Charles L Sprung, Mark E Nunnally, Bram Rochwerg, Gordon D Rubenfeld, Derek C Angus, Djillali Annane, Richard J Beale, Geoffrey J Bellinghan, Gordon R Bernard, Jean-Daniel Chiche, Craig Coopersmith, Daniel P De BackerCraig J French, Seitaro Fujishima, Herwig Gerlach, Jorge Luis Hidalgo, Steven M Hollenberg, Alan E Jones, Dilip R Karnad, Ruth M Kleinpell, Younsuck Koh, Thiago Costa Lisboa, Flavia R Machado, John J Marini, John C Marshall, John E Mazuski, Lauralyn A McIntyre, Anthony S McLean, Sangeeta Mehta, Rui P Moreno, John Myburgh, Paolo Navalesi, Osamu Nishida, Tiffany M Osborn, Anders Perner, Colleen M Plunkett, Marco Ranieri, Christa A Schorr, Maureen A Seckel, Christopher W Seymour, Lisa Shieh, Khalid A Shukri, Steven Q Simpson, Mervyn Singer, Taylor Thompson, Sean R Townsend, Thomas Van der Poll, Jean‑Louis Vincent, W Joost Wiersinga, Janice L Zimmerman, R Phillip Dellinger

Department of Clinical Medicine

1412 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Critical Care Medicine
Volume	45
Issue number	3
Pages (from-to)	486-552
ISSN	1063-7389
DOIs	https://doi.org/10.1097/CCM.0000000000002255
Publication status	Published - 1 Mar 2017

Keywords

Anti-Bacterial Agents/therapeutic use
Critical Care/standards
Fluid Therapy
Humans
Intensive Care Units
Nutritional Support
Respiration, Artificial
Resuscitation
Sepsis/diagnosis
Shock, Septic/diagnosis

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10.1097/CCM.0000000000002255

Cite this

Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., Rochwerg, B., Rubenfeld, G. D., Angus, D. C., Annane, D., Beale, R. J., Bellinghan, G. J., Bernard, G. R., Chiche, J-D., Coopersmith, C., ... Dellinger, R. P. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Critical Care Medicine, 45(3), 486-552. https://doi.org/10.1097/CCM.0000000000002255

Rhodes, A, Evans, LE, Alhazzani, W, Levy, MM, Antonelli, M, Ferrer, R, Kumar, A, Sevransky, JE, Sprung, CL, Nunnally, ME, Rochwerg, B, Rubenfeld, GD, Angus, DC, Annane, D, Beale, RJ, Bellinghan, GJ, Bernard, GR, Chiche, J-D, Coopersmith, C, De Backer, DP, French, CJ, Fujishima, S, Gerlach, H, Hidalgo, JL, Hollenberg, SM, Jones, AE, Karnad, DR, Kleinpell, RM, Koh, Y, Lisboa, TC, Machado, FR, Marini, JJ, Marshall, JC, Mazuski, JE, McIntyre, LA, McLean, AS, Mehta, S, Moreno, RP, Myburgh, J, Navalesi, P, Nishida, O, Osborn, TM, Perner, A, Plunkett, CM, Ranieri, M, Schorr, CA, Seckel, MA, Seymour, CW, Shieh, L, Shukri, KA, Simpson, SQ, Singer, M, Thompson, T, Townsend, SR, Van der Poll, T, Vincent, JL, Wiersinga, WJ, Zimmerman, JL & Dellinger, RP 2017, 'Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016', Critical Care Medicine, vol. 45, no. 3, pp. 486-552. https://doi.org/10.1097/CCM.0000000000002255

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title = "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016",

abstract = "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.",

keywords = "Anti-Bacterial Agents/therapeutic use, Critical Care/standards, Fluid Therapy, Humans, Intensive Care Units, Nutritional Support, Respiration, Artificial, Resuscitation, Sepsis/diagnosis, Shock, Septic/diagnosis",

author = "Andrew Rhodes and Evans, {Laura E} and Waleed Alhazzani and Levy, {Mitchell M} and Massimo Antonelli and Ricard Ferrer and Anand Kumar and Sevransky, {Jonathan E} and Sprung, {Charles L} and Nunnally, {Mark E} and Bram Rochwerg and Rubenfeld, {Gordon D} and Angus, {Derek C} and Djillali Annane and Beale, {Richard J} and Bellinghan, {Geoffrey J} and Bernard, {Gordon R} and Jean-Daniel Chiche and Craig Coopersmith and {De Backer}, {Daniel P} and French, {Craig J} and Seitaro Fujishima and Herwig Gerlach and Hidalgo, {Jorge Luis} and Hollenberg, {Steven M} and Jones, {Alan E} and Karnad, {Dilip R} and Kleinpell, {Ruth M} and Younsuck Koh and Lisboa, {Thiago Costa} and Machado, {Flavia R} and Marini, {John J} and Marshall, {John C} and Mazuski, {John E} and McIntyre, {Lauralyn A} and McLean, {Anthony S} and Sangeeta Mehta and Moreno, {Rui P} and John Myburgh and Paolo Navalesi and Osamu Nishida and Osborn, {Tiffany M} and Anders Perner and Plunkett, {Colleen M} and Marco Ranieri and Schorr, {Christa A} and Seckel, {Maureen A} and Seymour, {Christopher W} and Lisa Shieh and Shukri, {Khalid A} and Simpson, {Steven Q} and Mervyn Singer and Taylor Thompson and Townsend, {Sean R} and {Van der Poll}, Thomas and Jean‑Louis Vincent and Wiersinga, {W Joost} and Zimmerman, {Janice L} and Dellinger, {R Phillip}",

year = "2017",

month = mar,

day = "1",

doi = "10.1097/CCM.0000000000002255",

language = "English",

volume = "45",

pages = "486--552",

journal = "New Horizons: Science and Practice of Acute Medicine",

issn = "1063-7389",

publisher = "Williams & Wilkins",

number = "3",

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TY - JOUR

T1 - Surviving Sepsis Campaign

T2 - International Guidelines for Management of Sepsis and Septic Shock: 2016

AU - Rhodes, Andrew

AU - Evans, Laura E

AU - Alhazzani, Waleed

AU - Levy, Mitchell M

AU - Antonelli, Massimo

AU - Ferrer, Ricard

AU - Kumar, Anand

AU - Sevransky, Jonathan E

AU - Sprung, Charles L

AU - Nunnally, Mark E

AU - Rochwerg, Bram

AU - Rubenfeld, Gordon D

AU - Angus, Derek C

AU - Annane, Djillali

AU - Beale, Richard J

AU - Bellinghan, Geoffrey J

AU - Bernard, Gordon R

AU - Chiche, Jean-Daniel

AU - Coopersmith, Craig

AU - De Backer, Daniel P

AU - French, Craig J

AU - Fujishima, Seitaro

AU - Gerlach, Herwig

AU - Hidalgo, Jorge Luis

AU - Hollenberg, Steven M

AU - Jones, Alan E

AU - Karnad, Dilip R

AU - Kleinpell, Ruth M

AU - Koh, Younsuck

AU - Lisboa, Thiago Costa

AU - Machado, Flavia R

AU - Marini, John J

AU - Marshall, John C

AU - Mazuski, John E

AU - McIntyre, Lauralyn A

AU - McLean, Anthony S

AU - Mehta, Sangeeta

AU - Moreno, Rui P

AU - Myburgh, John

AU - Navalesi, Paolo

AU - Nishida, Osamu

AU - Osborn, Tiffany M

AU - Perner, Anders

AU - Plunkett, Colleen M

AU - Ranieri, Marco

AU - Schorr, Christa A

AU - Seckel, Maureen A

AU - Seymour, Christopher W

AU - Shieh, Lisa

AU - Shukri, Khalid A

AU - Simpson, Steven Q

AU - Singer, Mervyn

AU - Thompson, Taylor

AU - Townsend, Sean R

AU - Van der Poll, Thomas

AU - Vincent, Jean‑Louis

AU - Wiersinga, W Joost

AU - Zimmerman, Janice L

AU - Dellinger, R Phillip

PY - 2017/3/1

Y1 - 2017/3/1

N2 - 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.

AB - 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.

KW - Anti-Bacterial Agents/therapeutic use

KW - Critical Care/standards

KW - Fluid Therapy

KW - Humans

KW - Intensive Care Units

KW - Nutritional Support

KW - Respiration, Artificial

KW - Resuscitation

KW - Sepsis/diagnosis

KW - Shock, Septic/diagnosis

U2 - 10.1097/CCM.0000000000002255

DO - 10.1097/CCM.0000000000002255

M3 - Journal article

C2 - 28098591

SN - 1063-7389

VL - 45

SP - 486

EP - 552

JO - New Horizons: Science and Practice of Acute Medicine

JF - New Horizons: Science and Practice of Acute Medicine

IS - 3

ER -

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Abstract

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