Surviving Sepsis Campaign: Research Priorities for Sepsis and Septic Shock
Surviving Sepsis Campaign: Research Priorities for Sepsis and Septic Shock
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DOI：
10.1097/ccm.0000000000003225
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发表时间：
2018-08-01
影响因子：
8.8
通讯作者：
Rhodes, Andrew
中科院分区：
文献类型：
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作者：
Coopersmith, Craig M.;De Backer, Daniel;Rhodes, Andrew
目的：为了确定在管理，流行病学，结果和脓毒症和脓毒性shock.Design的根本原因的研究重点：一个共识委员会的16个国际专家代表欧洲重症监护医学学会和社会的危重病医学召开了两个社会的年度会议。分组举行了电话会议和电子讨论。整个委员会反复制定了整个文件和recommendations.Methods：每个委员会成员独立地给出了他们的前五名败血症研究的优先事项。委员会共同主席将总共88条建议（补充表1，补充数字内容2，http：//links.lww.com/CCM/D636）归类，形成7个亚组：感染、液体和血管活性药物、预防性治疗、给药/流行病学、评分/鉴定、重症监护病房后和基础/转化科学。每个分组都举行了电话会议，讨论每个优先事项，然后在每个分组内进行正式投票。整个委员会还投票决定了除基础/转化science.Results以外的所有子组的最高优先级：幸存脓毒症研究委员会为脓毒症和脓毒性休克提供了26个优先事项。其中，确定了前六个临床优先事项，包括以下问题：1）靶向/个性化/精准医学方法能否确定哪些疗法在哪些时间对哪些患者有效？; 2)容量复苏的理想终点是什么？容量复苏应如何滴定？3)临床实践中是否应该实施快速诊断试验？4)经验性抗生素联合治疗是否应用于脓毒症或脓毒性休克？5)脓毒症长期发病率和死亡率的预测因素是什么？和6）什么信息识别器官功能障碍？结论：虽然败血症生存运动指南对败血症的治疗提出了多项建议，但在直接适用于临床医生的床边问题以及理解败血症发展和进展的基本机制方面仍然存在重大的知识差距。确定的优先事项代表了脓毒症和脓毒性休克研究的路线图。
Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (Supplemental Table 1, Supplemental Digital Content 2, http://links.lww.com/CCM/D636) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science.Results: The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: 1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; 2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; 3) should rapid diagnostic tests be implemented in clinical practice?; 4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; 5) what are the predictors of sepsis long-term morbidity and mortality?; and 6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.