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Intensive Care Medicine
Published in: Intensive Care Medicine 1/2020

01-02-2020 | Septicemia | Guidelines

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Authors: Scott L. Weiss, Mark J. Peters, Waleed Alhazzani, Michael S. D. Agus, Heidi R. Flori, David P. Inwald, Simon Nadel, Luregn J. Schlapbach, Robert C. Tasker, Andrew C. Argent, Joe Brierley, Joseph Carcillo, Enitan D. Carrol, Christopher L. Carroll, Ira M. Cheifetz, Karen Choong, Jeffry J. Cies, Andrea T. Cruz, Daniele De Luca, Akash Deep, Saul N. Faust, Claudio Flauzino De Oliveira, Mark W. Hall, Paul Ishimine, Etienne Javouhey, Koen F. M. Joosten, Poonam Joshi, Oliver Karam, Martin C. J. Kneyber, Joris Lemson, Graeme MacLaren, Nilesh M. Mehta, Morten Hylander Møller, Christopher J. L. Newth, Trung C. Nguyen, Akira Nishisaki, Mark E. Nunnally, Margaret M. Parker, Raina M. Paul, Adrienne G. Randolph, Suchitra Ranjit, Lewis H. Romer, Halden F. Scott, Lyvonne N. Tume, Judy T. Verger, Eric A. Williams, Joshua Wolf, Hector R. Wong, Jerry J. Zimmerman, Niranjan Kissoon, Pierre Tissieres

Published in: Intensive Care Medicine | Special Issue 1/2020

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Abstract

Objectives

To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.

Design

A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process.

Methods

The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, “in our practice” statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate.

Results

The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, “in our practice” statements were provided. In addition, 52 research priorities were identified.

Conclusions

A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
Appendix
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Metadata
Title
Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children
Authors
Scott L. Weiss
Mark J. Peters
Waleed Alhazzani
Michael S. D. Agus
Heidi R. Flori
David P. Inwald
Simon Nadel
Luregn J. Schlapbach
Robert C. Tasker
Andrew C. Argent
Joe Brierley
Joseph Carcillo
Enitan D. Carrol
Christopher L. Carroll
Ira M. Cheifetz
Karen Choong
Jeffry J. Cies
Andrea T. Cruz
Daniele De Luca
Akash Deep
Saul N. Faust
Claudio Flauzino De Oliveira
Mark W. Hall
Paul Ishimine
Etienne Javouhey
Koen F. M. Joosten
Poonam Joshi
Oliver Karam
Martin C. J. Kneyber
Joris Lemson
Graeme MacLaren
Nilesh M. Mehta
Morten Hylander Møller
Christopher J. L. Newth
Trung C. Nguyen
Akira Nishisaki
Mark E. Nunnally
Margaret M. Parker
Raina M. Paul
Adrienne G. Randolph
Suchitra Ranjit
Lewis H. Romer
Halden F. Scott
Lyvonne N. Tume
Judy T. Verger
Eric A. Williams
Joshua Wolf
Hector R. Wong
Jerry J. Zimmerman
Niranjan Kissoon
Pierre Tissieres
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue Special Issue 1/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05878-6