Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Abstract

Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

Severe sepsis and cardiac arrhythmias

“…Although beta blockers and calcium channel blockers have proven successful in management of atrial arrhythmias (8), their use outside of atrial arrhythmias has not been tested and it may be a challenge to use them in setting of hypotension, which is a frequent occurrence in severe sepsis. Antibiotics and hemodynamic support, which includes volume resuscitation and use of vasopressors in severe cases are the mainstay therapy (9). Current sepsis treatment guidelines recommend norepinephrine, dopamine and dobutamine as first line vasopressor agents, they may not be the ideal choice in the setting of active or recurrent arrhythmias (9) in view of their pro-arrhythmic properties (33).…”

“…Antibiotics and hemodynamic support, which includes volume resuscitation and use of vasopressors in severe cases are the mainstay therapy (9). Current sepsis treatment guidelines recommend norepinephrine, dopamine and dobutamine as first line vasopressor agents, they may not be the ideal choice in the setting of active or recurrent arrhythmias (9) in view of their pro-arrhythmic properties (33). Despite lack of data to support this, in view of their virtual lack of affinity for beta receptors it appears intuitive to use vasopressors such as phenylephrine and (33).…”

“…Current treatment for atrial and ventricular arrhythmias in severe sepsis patients consists primarily of the utilization of calcium channel and beta-blockers (8). Although guidelines have been developed to manage severe sepsis in order to reduce morbidity and mortality in critical care patients, these have yet to significantly affect outcomes in patients who develop cardiac arrhythmias (8,9).…”

Focus on infection and sepsis 2017

“…Probably, one of the most important landmarks in 2016 was the publication of the new edition of the Surviving Sepsis Campaign guidelines [1]. Not all is done and new data will be incorporated in further editions.…”

Predictors of complications when transferring postoperative cardiac patients from the intensive care unit

“…Этот индекс прак-тически не зависит от условий пред-и постнагрузки, отражает степень выраженности сердечной недоста-точности, коррелирует с функциональным классом сердечной недостаточности и степенью толерантнос-ти к физической нагрузке, а также наравне с ФВ левого желудочка (ЛЖ) является независимым предиктором летального исхода [10]. Несмотря на возможность использования в периоперационном периоде цент-рального венозного давления или давления в правом предсердии [11,12], с учетом вероятного транспульмо-нального градиента, более точным показателем пред-нагрузки служит давление в левом предсердии, прямая оценка которого достаточно инвазивна. При интер-претации диастолической функции левого желудочка происходит оценка давлений в левых камерах сердца, в частности предложены формулы для неинвазивной оценки давлений в левом предсердии (Длп) на осно-вании скорости фронта трансмитрального кровотока (vp) или диастолической скорости движения кольца митрального клапана (e') при тканевой допплерографии (ТДИ): Длп(е') = 1,9 + 1,24 × Е/е' [13] …”