[Guidelines of hemodynamic monitor and support in adult patients with severe sepsis and septic shock (draft)].

Severe sepsis and septic shock are common causes of morbidity and mortality of intensive care unit (ICU) patients. There are an estimated 751,000 cases of severe sepsis each year in the US, with a mortality of 20%-63% and an annual health care cost of US$16.7 billion. Worldwide, 18 million cases of severe sepsis occur annually, killing approximately 1,400 people each day and a health care cost of US$9.4 billion in Europe alone. Despite advances in medical science, the overall mortality for severe sepsis and septic shock has been slightly improved only with passage of time. Although there are no solid statistics, it is a conjecture that the morbidity and mortality and health cure cost of severe sepsis and septic shock are quite high in China. Septic shock is primarily a form of distributional shock and usually characterized by high cardiac output and low systemic vascular resistance. In septic shock, patients can have both hypotension resulting from decreased systemic vascular resistance, and sequestration of blood in the microcirculation resulting in compromised tissue perfusion. It is important to outline a guideline for hemodynamic monitor and support in severe sepsis and septic shock patients to maintain adequate perfusion of organs and cellular oxygen uptake. A group of 9 critical care experts in the diagnosis and management of severe sepsis and septic shock, representing members of the Chinese Society of Critical Care Medicine (Chinese Medical Association), gathered together to develop this hemodynamic monitor and support guidelines to enable the bedside clinician to follow for the sake of improving the outcome in severe sepsis and septic shock patients. The recommendations, totally 21 items, are graded based on a modified Delphi methodology.