Fernández-Sarmiento Jaime, De Souza Daniela Carla, Martinez Anacaona, Nieto Victor, López-Herce Jesús, Soares Lanziotti Vanessa, Arias López María Del Pilar, De Carvalho Werther Brunow, Oliveira Claudio F, Jaramillo-Bustamante Juan Camilo, Díaz Franco, Yock-Corrales Adriana, Ruvinsky Silvina, Munaico Manuel, Pavlicich Viviana, Iramain Ricardo, Márquez Marta Patricia, González Gustavo, Yunge Mauricio, Tonial Cristian, Cruces Pablo, Palacio Gladys, Grela Carolina, Slöcker-Barrio Maria, Campos-Miño Santiago, González-Dambrauskas Sebastian, Sánchez-Pinto Nelson L, Celiny García Pedro, Jabornisky Roberto
Fundación Cardioinfantil - Instituto de Cardiología, Universidad de la Sabana, CES Graduate School, Bogotá, Colombia.
Hospital Universitario da Universidad de São Paulo and Hospital Sírio Libanês, Sao Paulo, Brazil.
J Intensive Care Med. 2022 Jun;37(6):753-763. doi: 10.1177/08850666211054444. Epub 2021 Nov 23.
The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in children in low- and middle-income countries (LMICs), more specifically in Latin America. A panel was formed consisting of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries. The experts were organized into 10 nominal groups, each coordinated by a member. A formal consensus was formed based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles. Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts reviewed the recommendations and suggestions. At the end of the 12 months of work, the consensus provided 62 recommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although 56 of these had a low level of evidence. These are the first consensus recommendations for the diagnosis and management of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America.
本研究的目的是为低收入和中等收入国家（LMICs），更具体地说是拉丁美洲的儿童脓毒症诊断和治疗制定基于证据的建议。成立了一个由27名具有儿童脓毒症治疗经验的专家和两名在拉丁美洲国家工作的方法学家组成的小组。专家们被分成10个名义小组，每个小组由一名成员协调。基于改良的德尔菲法形成了正式共识，将专家名义小组的意见与现有科学证据的解释相结合，通过一个系统的过程整合一系列建议。系统检索由一名专业图书馆员进行，包括针对Cochrane专业注册库、PubMed、Lilacs和Scopus的特定算法，以及针对灰色文献的OpenGrey数据库。使用GRADEpro GDT指南对每篇选定的文章进行分类。特别强调了包括在低收入和中等收入国家进行的原始研究的搜索引擎。涵盖了英文、西班牙文和葡萄牙文的研究。通过2020年2月至2021年2月期间举行的虚拟会议，全体专家对建议和意见进行了审查。在12个月的工作结束时，该共识为低收入和中等收入国家儿童脓毒症的诊断和治疗提供了62条建议。总体而言，60条是强烈建议，尽管其中56条证据水平较低。这些是针对低收入和中等收入国家，更具体地说是拉丁美洲国家儿童脓毒症诊断和管理的首批共识建议。该共识表明，在这些儿童脓毒症负担高于高收入国家的地区，几乎没有高水平的证据。尽管存在局限性，但这一共识是拉丁美洲儿童脓毒症诊断和治疗向前迈出的重要一步。
