Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

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  • Laura Evans
    Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA.
  • Andrew Rhodes
    Adult Critical Care, St. George’s University Hospitals NHS Foundation Trust & St. George’s University of London, London, UK.
  • Waleed Alhazzani
    Department of Medicine, McMaster University, Canada & Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Massimo Antonelli
    Dipartimento di Scienze dell’ Emergenza Anestesiologiche e della Rianimazione, Policlinico Universitario A. Gemelli IRCCS Rome, Italy.
  • Craig M. Coopersmith
    Emory University School of Medicine, Atlanta, Georgia, USA
  • Craig French
    Western Health, Melbourne, Australia.
  • Flávia R. Machado
    Anesthesiology, Pain and Intensive Care Department, Federal University of São Paolo, São Paulo, Brazil.
  • Lauralyn Mcintyre
    Ottawa Hospital, Ottawa, Ontario, Canada.
  • Marlies Ostermann
    Guy’s & St Thomas’ Hospital, London, England, UK.
  • Hallie C. Prescott
    University of Michigan and VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.
  • Christa Schorr
    Cooper Health System, Camden, New Jersey, USA.
  • Steven Simpson
    University of Kansas Medical Center, Kansas City, Kansas, USA.
  • W. Joost Wiersinga
    ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • Fayez Alshamsi
    Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
  • Derek C. Angus
    University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, Pennsylvania, USA.
  • Yaseen Arabi
    Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
  • Luciano Azevedo
    University of São Paulo, School of Medicine, São Paolo, Brazil.
  • Richard Beale
    Guy’s & St Thomas’ Hospital, London, UK.
  • Gregory Beilman
    University of Minnesota, Minneapolis, Minnesota, USA.
  • Emilie Belley-Cote
    Population Health Research Institute, Hamilton, Ontario, Canada.
  • Lisa Burry
    Mount Sinai Hospital & University of Toronto (Leslie Dan Faculty of Pharmacy),Toronto, Ontario, Canada.
  • Maurizio Cecconi
    Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy; Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
  • John Centofanti
    Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
  • Angel Coz Yataco
    Lexington Veterans Affairs Medical Center/University of Kentucky College of Medicine, Lexington, Kentucky, USA.
  • Jan De Waele
    Ghent University Hospital, Ghent, Belgium.
  • R. Phillip Dellinger
    Cooper Health System, Camden, New Jersey, USA.
  • Kent Doi
    The University of Tokyo, Tokyo, Japan.
  • Bin Du
    Medical ICU, Peking Union Medical College Hospital, Beijing, China.
  • Elisa Estenssoro
    Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina.
  • Ricard Ferrer
    Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Institut de Recerca, Barcelona, Spain.
  • Charles Gomersall
    Prince of Wales Hospital, Hong Kong, China.
  • Carol Hodgson
    Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
  • Morten Hylander Møller
    Copenhagen University Hospital Rigshospitalet, Department of Intensive Care, Copenhagen, Denmark.
  • Theodore Iwashyna
    University of Michigan Health System, Ann Arbor, Michigan, USA.
  • Shevin Jacob
    Liverpool School of Tropical Medicine, Liverpool, UK.
  • Ruth Kleinpell
    Vanderbilt University, Nashville, Tennessee, USA.
  • Michael Klompas
    Department of Medicine, Brigham and Women’s Hospital, Boston MA; Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
  • Younsuck Koh
    ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
  • Anand Kumar
    University of Manitoba, Winnipeg, MB, Canada.
  • Arthur Kwizera
    Makerere University College of Health Sciences, Kampala, Uganda.
  • Suzana Lobo
    Intensive Care Division. Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil.
  • Henry Masur
    Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, USA.
  • Steven McGloughlin
    Alfred Health, Melbourne, Australia.
  • Sangeeta Mehta
    Mount Sinai Hospital, Toronto, Ontario, Canada.
  • Yatin Mehta
    Medanta The Medicity, Gurugram, Haryana, India.
  • Mervyn Mer
    Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Mark Nunnally
    New York University School of Medicine, New York, New York, USA.
  • Simon Oczkowski
    Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Tiffany Osborn
    Washington University School of Medicine, St. Louis, Missouri, USA.
  • Elizabeth Papathanassoglou
    Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
  • Anders Perner
    Rigshospitalet, Copenhagen, Denmark.
  • Michael Puskarich
    University of Minnesota/Hennepin County Medical Center, Minneapolis, Minnesota, USA.
  • Jason Roberts
    University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia, Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia, Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France.
  • William Schweickert
    University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Maureen Seckel
    ChristianaCare, Newark, Delaware, USA.
  • Jonathan Sevransky
    Emory University School of Medicine, Atlanta, Georgia, USA.
  • Charles L. Sprung
    Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Jerusalem, Israel.
  • Tobias Welte
    Medizinische Hochschule Hannover and German Center of Lung Research (DZL), Hannover, Germany.
  • Janice Zimmerman
    World Federation of Intensive and Critical Care, Brussels, Belgium.
  • Mitchell Levy
    Warren Alpert School of Medicine at Brown University, Providence, Rhode Island & Rhode Island Hospital, Providence, Rhode Island, USA.

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Description

Background\ud Sepsis poses a global threat to millions of lives. The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications.\ud Methods\ud We formed a panel of 60 experts from 22 countries and 11 members of the public. The panel prioritized questions that are relevant to the recognition and management of sepsis and septic shock in adults. New questions and sections were addressed, relative to the previous guidelines. These questions were grouped under 6 subgroups (screening and early treatment, infection, hemodynamics, ventilation, additional therapies, and long-term outcomes and goals of care). With input from the panel and methodologists, professional medical librarians performed the search strategy tailored to either specific questions or a group of relevant questions. A dedicated systematic review team performed screening and data abstraction when indicated. For each question, the methodologists, with input from panel members, summarized the evidence assessed and graded the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The panel generated recommendations using the evidence-to-decision framework. Recommendations were either strong or weak, or in the form of best practice statements. When evidence was insufficient to support a recommendation, the panel was surveyed to generate “in our practice” statements.\ud Results\ud The SSC panel issued 93 statements: 15 best practice statements, 15 strong recommendations, and 54 weak recommendations and no recommendation was provided for 9 questions. The recommendations address several important clinical areas related to screening tools, acute resuscitation strategies, management of fluids and vasoactive agents, antimicrobials and diagnostic tests and the use of additional therapies, ventilation management, goals of care, and post sepsis care.\ud Conclusion\ud The SSC panel issued evidence-based recommendations to help support key stakeholders caring for adults with sepsis or septic shock and their families.

Journal

  • Critical Care Medicine

    Critical Care Medicine 49 (11), e1063-e1143, 2021-10-14

    Ovid Technologies (Wolters Kluwer Health)

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