Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

Abstract

Objective: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock," published in 2004. Design: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. Methods: We used the GRADE system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation [1] indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost), or clearly do not. Weak recommendations [2] indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied.

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

“…Norepinephrine (a and b-adrenergic, Table 2) is the most commonly advocated vasopressive drug in septic shock to maintain mean arterial pressure (MAP) at a minimum level of 65 mmHg [12]. Although suggested, improvement of outcome as a result of the use of NE has never been established [24].…”

Estratégia de detecção precoce e redução de mortalidade na sepse grave

“…Respectively, "6 hours bundle" and 24 hours bundle". ( 5,6) At the first stage, compliance to these bundles (6 hours = 17%; 24 hours = 30%) was even higher that that observed by SSC worldwide (6 hours= 13%; 24 hours = 15%). (17) Notwithstanding the good performance regarding management of severe sepsis., mortality remained unacceptably high (67,6%).…”

“…(1,5,6,(29)(30)(31) At the same time, international consensus that reviewed SIRS criteria, concluded that: "… these criteria are excessively sensitive and not specific". (29,30) This makes identification and dealing with such a common and lethal syndrome even more difficult.…”

“…Sepsis is considered severe when there is at least one associated organ dysfunction and, if hypotension persists regardless of vigorous administration of water, it is septic shock. (1) It was proven that adopting the therapeutic strategy proposed by the Serving Sepsis Campaign (SSC) that includes early tissue reperfusion and control of the infection focus, (2,5,6) bring about decreased mortality. (7)(8)(9)(10)(11)(12)(13)(14) In our hospital, as well as in other Brazilian institutions, notwithstanding adhesion to SSC, mortality rates continue to be unacceptably high.…”

Impact of Protocol Watch on Compliance With the Surviving Sepsis Campaign

“…The guidelines were updated in 2008 by using an evidence-based method for assessment of the quality of evidence and strength of recommendations. 8 Key recommendations include initiation of early goaldirected therapy (EGDT) during the first 6 hours following onset of indications of sepsis, including hypoperfusion to sustain central venous pressure between 8 and 12 mm Hg, mean arterial pressure at 65 mm Hg or greater, urine output at 0.5 mL/kg per hour, and central or mixed oxygen saturation of at least 70% or 65%. 8 In addition, SSC guidelines recommend early administration of broad-spectrum antibiotic therapy following evaluation of appropriate cultures and reassessment of the impact of such therapy based on microbiologic assays and clinical responses to refine coverage.…”