Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain; Centro de Investigacion Biomedica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Scientifical Research, CHU Nîmes, University Montpellier-Nîmes, Nîmes, France.
Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain; Centro de Investigacion Biomedica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Anaesth Crit Care Pain Med. 2020 Aug;39(4):497-502. doi: 10.1016/j.accpm.2020.06.015. Epub 2020 Jul 7.
The Surviving Sepsis Campaign (SSC) guidelines, released in 2017, are a combination of expert opinion and evidence-based medicine, adopted by many institutions as a standard of practice. The aim was to analyse the quality of evidence supporting recommendations on the management of sepsis.
The strength and quality of evidence (high, moderate, low-very low and best practice statements) of each recommendation were extracted. Randomised controlled trials were required to qualify as high-quality evidence.
A total of 96 recommendations were formulated, and 87 were included. Among thirty-one (43%) strong recommendations, only 15.2% were supported by high-quality evidence. Overall, thirty-seven (42.5%) recommendations were based on low-quality evidence, followed by 28 (32.2%) based on moderate-quality, 15 (17.2%) were best practice statements and only seven (8.0%) were supported by high-quality evidence. Randomised controlled trials supported 21.4%, 9.5% and 8.6% recommendations on mechanical ventilation, resuscitation, and management/adjuvant therapy, respectively. In contrast, none high-quality evidence recommendation supported antimicrobial/source control (82.4% were low-very low evidence or best practice statements), and nutrition.
In the SSC guidelines most recommendations were informed by indirect evidence and non-systematic observations. While awaiting trials results, Delphi-like approaches or multi-criteria decision analyses should guide recommendations.
2017 年发布的拯救脓毒症运动（SSC）指南是专家意见和循证医学的结合，被许多机构采用为实践标准。其目的是分析支持脓毒症管理建议的证据质量。
提取了每条建议的证据强度和质量（高、中、低-极低和最佳实践陈述）。随机对照试验必须符合高质量证据的标准。
共制定了 96 条建议，其中 87 条被纳入。在 31 条（43%）强烈推荐中，只有 15.2%得到了高质量证据的支持。总的来说，37 条（42.5%）建议基于低质量证据，其次是 28 条（32.2%）基于中等质量证据，15 条（17.2%）是最佳实践陈述，只有 7 条（8.0%）得到了高质量证据的支持。随机对照试验分别支持机械通气、复苏和治疗/辅助治疗的 21.4%、9.5%和 8.6%的建议。相比之下，没有高质量证据的建议支持抗菌药物/源控制（82.4%是低-极低证据或最佳实践陈述）和营养。
在 SSC 指南中，大多数建议都是基于间接证据和非系统性观察。在等待试验结果的同时，德尔菲式方法或多标准决策分析应该指导建议。
