Amer Marwa, Møller Morten Hylander, Granholm Anders, Alotaibi Haifa F, AlMuhaidib Shadan, Al Duhailib Zainab, Arafat Amr, Chew Michelle S, Rehn Marius, Sigurðsson Martin Ingi, Kalliomäki Maija-Liisa, Olkkola Klaus T, Jalkanen Ville, Szczeklik Wojciech, Alshaqaq Hassan M, Lewis Kimberley, Carayannopoulos Kallirroi Laiya, Honarmand Kimia, Chaudhuri Dipayan, Alquraini Mustafa, Amer Yasser S, Alshamsi Fayez, Alhazzani Waleed
Medical/Critical Pharmacy Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Acta Anaesthesiol Scand. 2025 Jul;69(6):e70036. doi: 10.1111/aas.70036.
Sepsis is a leading cause of mortality worldwide, characterized by a dysregulated host response to infection. Despite the development of multiple clinical practice guidelines (CPGs) to standardize sepsis management, substantial variability exists in methodological quality and key clinical recommendations. This inconsistency complicates guideline implementation and potentially affects patient outcomes. The proposed systematic methodological review aims to evaluate the quality and consistency of sepsis guidelines to identify areas for improvement and provide actionable insights for guideline developers.
This protocol outlines a systematic methodological review of sepsis CPGs published over the last two decades (2004-2025). A comprehensive search strategy will be conducted across PubMed, EMBASE, the Cochrane Library, and the official websites of professional societies to identify relevant guidelines. The inclusion criteria are CPGs targeting adult sepsis management published by recognized medical or governmental organizations with detailed methodological descriptions. We will use the Appraisal of Guidelines for Research and Evaluation II instrument to assess methodological quality across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Data extraction will focus on key clinical recommendations, including fluid resuscitation, antimicrobial therapy, vasopressor and inotrope use, corticosteroids, source control, blood glucose management, hemodynamic management, and mechanical ventilation management. The consistency of the recommendations will be analyzed, and trends in guideline quality over time will be evaluated. Artificial intelligence (AI) tools will be evaluated for data extraction processes in systematic reviews to determine their capacity for efficiency and accuracy in extracting data compared to human-driven methods.
By systematically appraising the quality and consistency of sepsis guidelines, this review aims to address the existing gaps and discrepancies in guideline development and application. These findings will provide valuable insights into the evolution of sepsis guideline quality, highlight areas for improvement, and support the development of more robust evidence-based recommendations. These results will inform clinicians and guideline developers, ultimately enhancing the standardization and effectiveness of sepsis management worldwide. Integrating AI into the review process represents a novel methodological advancement that streamlines data extraction and analysis.
脓毒症是全球主要的死亡原因，其特征是宿主对感染的反应失调。尽管制定了多项临床实践指南（CPG）以规范脓毒症管理，但方法学质量和关键临床建议仍存在很大差异。这种不一致使指南的实施变得复杂，并可能影响患者的治疗结果。拟进行的系统方法学综述旨在评估脓毒症指南的质量和一致性，以确定改进领域，并为指南制定者提供可行的见解。
本方案概述了对过去二十年（2004 - 2025年）发表的脓毒症CPG进行的系统方法学综述。将在PubMed、EMBASE、Cochrane图书馆以及专业协会的官方网站上进行全面的检索策略，以识别相关指南。纳入标准是由公认的医学或政府组织发布的针对成人脓毒症管理的CPG，且有详细的方法学描述。我们将使用《研究与评价指南II》工具，从六个领域评估方法学质量：范围和目的、利益相关者参与、制定的严谨性、表述的清晰度、适用性和编辑独立性。数据提取将集中在关键临床建议上，包括液体复苏、抗菌治疗、血管活性药物和正性肌力药物的使用、皮质类固醇、源头控制、血糖管理、血流动力学管理和机械通气管理。将分析建议的一致性，并评估指南质量随时间的趋势。将评估人工智能（AI）工具在系统综述数据提取过程中的作用，以确定其与人工驱动方法相比在提取数据方面的效率和准确性。
通过系统评估脓毒症指南的质量和一致性，本综述旨在解决指南制定和应用中现有的差距和差异。这些发现将为脓毒症指南质量的演变提供有价值的见解，突出改进领域，并支持制定更有力的循证建议。这些结果将为临床医生和指南制定者提供信息，最终提高全球脓毒症管理的标准化和有效性。将AI整合到综述过程中代表了一种新颖的方法学进步，可简化数据提取和分析。
