拯救脓毒症运动：脓毒症与脓毒性休克管理国际指南：2016版
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
作者信息
Rhodes Andrew, Evans Laura E, Alhazzani Waleed, Levy Mitchell M, Antonelli Massimo, Ferrer Ricard, Kumar Anand, Sevransky Jonathan E, Sprung Charles L, Nunnally Mark E, Rochwerg Bram, Rubenfeld Gordon D, Angus Derek C, Annane Djillali, Beale Richard J, Bellinghan Geoffrey J, Bernard Gordon R, Chiche Jean-Daniel, Coopersmith Craig, De Backer Daniel P, French Craig J, Fujishima Seitaro, Gerlach Herwig, Hidalgo Jorge Luis, Hollenberg Steven M, Jones Alan E, Karnad Dilip R, Kleinpell Ruth M, Koh Younsuck, Lisboa Thiago Costa, Machado Flavia R, Marini John J, Marshall John C, Mazuski John E, McIntyre Lauralyn A, McLean Anthony S, Mehta Sangeeta, Moreno Rui P, Myburgh John, Navalesi Paolo, Nishida Osamu, Osborn Tiffany M, Perner Anders, Plunkett Colleen M, Ranieri Marco, Schorr Christa A, Seckel Maureen A, Seymour Christopher W, Shieh Lisa, Shukri Khalid A, Simpson Steven Q, Singer Mervyn, Thompson B Taylor, Townsend Sean R, Van der Poll Thomas, Vincent Jean-Louis, Wiersinga W Joost, Zimmerman Janice L, Dellinger R Phillip
机构信息
1St. George's Hospital London, England, United Kingdom. 2New York University School of Medicine New York, NY. 3McMaster University Hamilton, Ontario, Canada. 4Brown University School of Medicine Providence, RI. 5Instituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy. 6Vall d'Hebron University Hospital Barcelona, Spain. 7University of Manitoba Winnipeg, Manitoba, Canada. 8Emory University Hospital Atlanta, GA. 9Hadassah Hebrew University Medical Center Jerusalem, Israel. 10Sunnybrook Health Sciences Centre Toronto, Ontario, Canada. 11University of Pittsburgh Critical Care Medicine CRISMA Laboratory Pittsburgh, PA. 12Hospital Raymond Poincare Garches, France. 13Saint Thomas Hospital London, England, United Kingdom. 14University College London Hospitals London, England, United Kingdom. 15Vanderbilt University Medical Center Nashville, TN. 16Service de Reanimation Medicale Paris, France. 17CHIREC Hospitals Braine L'Alleud, Belgium. 18Western Hospital Victoria, Australia. 19Keio University School of Medicine, Tokyo, Japan. 20Vivantes-Klinikum Neukölln, Berlin, Germany. 21Karl Heusner Memorial Hospital Belize Healthcare Partners Belize City, Belize. 22Cooper Health System Camden, NJ. 23University of Mississippi Medical Center Jackson, MS. 24Jupiter Hospital Thane, India. 25Rush University Medical Center Chicago, IL. 26ASAN Medical Center University of Ulsan College of Medicine Seoul, South Korea. 27Hospital de Clinicas de Porto Alegre Porto Alegre, Brazil. 28Federal University of Sao Paulo Sao Paulo, Brazil. 29Regions Hospital St. Paul, MN. 30Saint Michael's Hospital Toronto, Ontario, Canada. 31Washington University School of Medicine St. Louis, MO. 32Ottawa Hospital Ottawa, Ontario, Canada. 33Nepean Hospital, University of Sydney Penrith, New South Wales, Australia. 34Mount Sinai Hospital Toronto, Ontario, Canada. 35UCINC, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. 36University of New South Wales, Sydney, New South Wales, Australia. 37Università dellla Magna Graecia Catanzaro, Italy. 38Fujita Health University School of Medicine, Toyoake, Aich, Japan. 39Rigshospitalet Copenhagen, Denmark. 40Università Sapienza, Rome, Italy. 41Christiana Care Health Services Newark, DE. 42University of Pittsburgh School of Medicine Pittsburgh, PA. 43Stanford University School of Medicine Stanford, CA. 44Kaust Medical Services Thuwal, Saudi Arabia. 45University of Kansas Medical Center Kansas City, KS. 46Wolfson Institute of Biomedical Research London, England, United Kingdom. 47Massachusetts General Hospital Boston, MA. 48California Pacific Medical Center San Francisco, CA. 49University of Amsterdam Amsterdam, Netherlands. 50Erasmé University Hospital Brussels, Belgium. 51University of Amsterdam, Amsterdam, Netherlands. 52Houston Methodist Hospital, Houston, TX.
出版信息
Crit Care Med. 2017 Mar;45(3):486-552. doi: 10.1097/CCM.0000000000002255.
OBJECTIVE
To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012."
DESIGN
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
目的
对《拯救脓毒症运动：脓毒症和脓毒性休克管理指南2012》进行更新。
设计
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。在重要国际会议上组建了名义小组（针对参会的委员会成员）。在流程开始时制定了正式的利益冲突（COI）政策并贯穿始终。2015年12月为所有小组成员召开了一次独立会议。各子组之间以及整个委员会之间的电话会议和基于电子的讨论是制定过程的一个组成部分。
方法
该小组由五个部分组成：血流动力学、感染、辅助治疗、代谢和通气。根据需要对人群、干预措施、对照和结局（PICO）问题进行审查和更新，并生成证据概况。每个子组列出问题清单，寻找最佳可得证据，然后遵循推荐分级评估、制定和评价（GRADE）系统的原则，将证据质量从高到极低进行评估，并在适用时将推荐制定为强推荐或弱推荐，或最佳实践声明。
结果
拯救脓毒症指南小组就脓毒症或脓毒性休克患者的早期管理和复苏提供了93条声明。总体而言，32条为强推荐，39条为弱推荐，18条为最佳实践声明。对于四个问题未提供推荐。
结论
一大批国际专家就脓毒症患者最佳护理的许多强推荐达成了实质性共识。尽管护理的许多方面支持相对较弱，但关于脓毒症和脓毒性休克急性管理的循证推荐是改善这些高死亡率重症患者结局的基础。
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