Thwaites Louise, Nasa Prashant, Abbenbroek Brett, Dat Vu Quoc, Finfer Simon, Kwizera Arthur, Ling Lowell, Lobo Suzana M, Sinto Robert, Aditianingsih Dita, Antonelli Massimo, Arabi Yaseen M, Argent Andrew, Azevedo Luciano, Bennett Elizabeth, Chakrabarti Arunaloke, De Asis Kevin, De Waele Jan, Divatia Jigeeshu Vasishtha, Estenssoro Elisa, Evans Laura, Faiz Abul, Hammond Naomi E, Hashmi Madiha, Herridge Margaret S, Jacob Shevin T, Jatsho Jimba, Javeri Yash, Khalid Karima, Chen Lie Khie, Levy Mitchell, Lundeg Ganbold, Machado Flavia R, Mehta Yatin, Mer Mervyn, Son Do Ngoc, Ospina-Tascón Gustavo A, Ostermann Marlies, Permpikul Chairat, Prescott Hallie C, Reinhart Konrad, Rodriguez Vega Gloria, S-Kabara Halima, Shrestha Gentle Sunder, Waweru-Siika Wangari, Tan Toh Leong, Todi Subhash, Tripathy Swagata, Venkatesh Balasubramaniam, Vincent Jean-Louis, Myatra Sheila Nainan
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates.
Intensive Care Med. 2025 Jan;51(1):21-38. doi: 10.1007/s00134-024-07735-7. Epub 2024 Dec 23.
To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings.
An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the final consensus statements.
A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include consensus on managing patients with sepsis outside a designated critical care area, triggers for escalating clinical management and criteria for safe transfer to another facility. The experts agreed on the following: in the absence of serum lactate, clinical parameters such as altered mental status, capillary refill time and urine output may be used to guide resuscitation; special considerations regarding the volume of fluid used for resuscitation, especially in tropical infections, including the use of simple tests to assess fluid responsiveness when facilities for advanced hemodynamic monitoring are limited; use of Ringer's lactate or Hartmann's solution as balanced salt solutions; epinephrine when norepinephrine or vasopressin are unavailable; and the administration of vasopressors via a peripheral vein if central venous access is unavailable or not feasible. Similarly, where facilities for investigation are unavailable, there was consensus for empirical antimicrobial administration without delay when sepsis was strongly suspected, as was the empirical use of antiparasitic agents in patients with suspicion of parasitic infections.
Using a Delphi method, international experts reached consensus to generate expert clinical practice statements providing guidance to clinicians worldwide on the management of sepsis in resource-limited settings. These statements complement existing guidelines where evidence is lacking and add relevant aspects of sepsis management that are not addressed by current international guidelines. Future studies are needed to assess the effects of these practice statements and address remaining uncertainties.
就资源有限环境下成人脓毒症的管理达成共识并提供专家临床实践声明。
亚太脓毒症联盟（APSA）召集了一个在脓毒症管理方面具有专业知识且包括一名德尔菲法专家的国际多学科指导委员会。该委员会挑选了一个在脓毒症管理方面具有专业知识的国际临床医生和研究人员小组。采用基于迭代方法的德尔菲法来获得最终的共识声明。
经过四轮调查，41位专家对30条（94%）声明达成了稳定的共识。这些共识包括在指定重症监护区域之外管理脓毒症患者、临床管理升级的触发因素以及安全转至另一机构的标准。专家们达成了以下共识：在没有血清乳酸的情况下，诸如精神状态改变、毛细血管再充盈时间和尿量等临床参数可用于指导复苏；复苏所用液体量的特殊考量，尤其是在热带感染中，包括在高级血流动力学监测设备有限时使用简单测试来评估液体反应性；使用乳酸林格氏液或哈特曼氏溶液作为平衡盐溶液；在去甲肾上腺素或血管加压素无法获得时使用肾上腺素；如果无法获得或不可行中心静脉通路，则通过外周静脉给予血管加压药。同样，在没有检查设备的情况下，当强烈怀疑脓毒症时应立即进行经验性抗菌药物给药，对于怀疑寄生虫感染的患者应经验性使用抗寄生虫药物也达成了共识。
通过德尔菲法，国际专家达成共识，生成了专家临床实践声明，为全球临床医生在资源有限环境下管理脓毒症提供指导。这些声明在缺乏证据的情况下补充了现有指南，并增加了当前国际指南未涉及的脓毒症管理相关方面。未来需要进行研究以评估这些实践声明的效果并解决剩余的不确定性。
