Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
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DOI：
10.1007/s00134-017-4683-6
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发表时间：
2017-03-01
影响因子：
38.9
通讯作者：
Dellinger, R. Phillip
中科院分区：
文献类型：
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作者：
Rhodes, Andrew;Evans, Laura E.;Dellinger, R. Phillip
为了更新“脓毒症和脓毒性休克管理指南：2012年”，召集了一个由代表25个国际组织的55名国际专家组成的共识委员会。名义上的团体在重要的国际会议上聚集（对于那些参加会议的委员会成员）。正式的利益冲突（COI）政策是在过程的开始制定和执行。2015年12月，为所有小组成员举行了一次单独会议。小组和整个委员会之间的电子会议和讨论是开发的一个组成部分。小组由五个部分组成：血液动力学，感染，预防性治疗，代谢和通气。根据需要审查和更新人群、干预、比较和结局（皮科）问题，并生成证据特征。每个小组生成一个问题列表，搜索现有的最佳证据，然后遵循建议评估、发展和评价分级（GRADE）系统的原则，从高到极低评估证据质量，并将建议制定为强或弱，生存脓毒症指南小组提供了93份关于脓毒症患者早期管理和复苏的声明，败血性休克总体而言，32项是强有力的建议，39项是弱有力的建议，18项是最佳做法说明。有四个问题没有提供建议。大量国际专家对脓毒症患者的最佳护理提出了许多强有力的建议，但他们之间存在实质性的一致意见。虽然护理的许多方面的支持相对较弱，但关于脓毒症和脓毒性休克急性管理的循证建议是改善这些死亡率高的危重患者结局的基础。
To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".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.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.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.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.