Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Laura Evans; Andrew Rhodes; Waleed Alhazzani; Massimo Antonelli; Craig M. Coopersmith; Craig French; Flávia R. MacHado; Lauralyn McIntyre; Marlies Ostermann; Hallie C. Prescott; Christa Schorr; Steven Simpson; W. Joost Wiersinga; Fayez Alshamsi; Derek C. Angus; Yaseen Arabi; Luciano Azevedo; Richard Beale; Gregory Beilman; Emilie Belley-Cote; Lisa Burry; Maurizio Cecconi; John Centofanti; Angel Coz Yataco; Jan De Waele; R. Phillip Dellinger; Kent Doi; Bin Du; Elisa Estenssoro; Ricard Ferrer; Charles Gomersall; Carol Hodgson; Morten Hylander Møller; Theodore Iwashyna; Shevin Jacob; Ruth Kleinpell; Michael Klompas; Younsuck Koh; Anand Kumar; Arthur Kwizera; Suzana Lobo; Henry Masur; Steven McGloughlin; Sangeeta Mehta; Yatin Mehta; Mervyn Mer; Mark Nunnally; Simon Oczkowski; Tiffany Osborn; Elizabeth Papathanassoglou; Anders Perner; Michael Puskarich; Jason Roberts; William Schweickert; Maureen Seckel; Jonathan Sevransky; Charles L. Sprung; Tobias Welte; Janice Zimmerman; Mitchell Levy

doi:10.1097/ccm.0000000000005337

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Laura Evans, Andrew Rhodes, Waleed Alhazzani, Massimo Antonelli, Craig M. Coopersmith, Craig French, Flávia R. MacHado, Lauralyn McIntyre, Marlies Ostermann, Hallie C. Prescott, Christa Schorr, Steven Simpson, W. Joost Wiersinga, Fayez Alshamsi, Derek C. Angus, Yaseen Arabi, Luciano Azevedo, Richard Beale, Gregory Beilman, Emilie Belley-CoteLisa Burry, Maurizio Cecconi, John Centofanti, Angel Coz Yataco, Jan De Waele, R. Phillip Dellinger, Kent Doi, Bin Du, Elisa Estenssoro, Ricard Ferrer, Charles Gomersall, Carol Hodgson, Morten Hylander Møller, Theodore Iwashyna, Shevin Jacob, Ruth Kleinpell, Michael Klompas, Younsuck Koh, Anand Kumar, Arthur Kwizera, Suzana Lobo, Henry Masur, Steven McGloughlin, Sangeeta Mehta, Yatin Mehta, Mervyn Mer, Mark Nunnally, Simon Oczkowski, Tiffany Osborn, Elizabeth Papathanassoglou, Anders Perner, Michael Puskarich, Jason Roberts, William Schweickert, Maureen Seckel, Jonathan Sevransky, Charles L. Sprung, Tobias Welte, Janice Zimmerman, Mitchell Levy

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

1849 Citations (Scopus)

Abstract

Background

Sepsis poses a global threat to millions of lives. The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications.

Methods

We formed a panel of 60 experts from 22 countries and 11 members of the public. The panel prioritized questions that are relevant to the recognition and management of sepsis and septic shock in adults. New questions and sections were addressed, relative to the previous guidelines. These questions were grouped under 6 subgroups (screening and early treatment, infection, hemodynamics, ventilation, additional therapies, and long-term outcomes and goals of care). With input from the panel and methodologists, professional medical librarians performed the search strategy tailored to either specific questions or a group of relevant questions. A dedicated systematic review team performed screening and data abstraction when indicated. For each question, the methodologists, with input from panel members, summarized the evidence assessed and graded the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The panel generated recommendations using the evidence-to-decision framework. Recommendations were either strong or weak, or in the form of best practice statements. When evidence was insufficient to support a recommendation, the panel was surveyed to generate “in our practice” statements.

Results

The SSC panel issued 93 statements: 15 best practice statements, 15 strong recommendations, and 54 weak recommendations and no recommendation was provided for 9 questions. The recommendations address several important clinical areas related to screening tools, acute resuscitation strategies, management of fluids and vasoactive agents, antimicrobials and diagnostic tests and the use of additional therapies, ventilation management, goals of care, and post sepsis care.

Conclusion

The SSC panel issued evidence-based recommendations to help support key stakeholders caring for adults with sepsis or septic shock and their families.

Original language	English
Pages (from-to)	e1063-e1143
Journal	Critical Care Medicine
Volume	49
Issue number	11
Early online date	2 Oct 2021
DOIs	https://doi.org/10.1097/ccm.0000000000005337
Publication status	Published - 1 Nov 2021

Keywords

Adults
evidence-based medicine
guidelines
sepsis
septic shock

Access to Document

10.1097/ccm.0000000000005337

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Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., MacHado, F. R., McIntyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., ... Levy, M. (2021). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine, 49(11), e1063-e1143. https://doi.org/10.1097/ccm.0000000000005337

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title = "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021",

abstract = "BackgroundSepsis poses a global threat to millions of lives. The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications.MethodsWe formed a panel of 60 experts from 22 countries and 11 members of the public. The panel prioritized questions that are relevant to the recognition and management of sepsis and septic shock in adults. New questions and sections were addressed, relative to the previous guidelines. These questions were grouped under 6 subgroups (screening and early treatment, infection, hemodynamics, ventilation, additional therapies, and long-term outcomes and goals of care). With input from the panel and methodologists, professional medical librarians performed the search strategy tailored to either specific questions or a group of relevant questions. A dedicated systematic review team performed screening and data abstraction when indicated. For each question, the methodologists, with input from panel members, summarized the evidence assessed and graded the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The panel generated recommendations using the evidence-to-decision framework. Recommendations were either strong or weak, or in the form of best practice statements. When evidence was insufficient to support a recommendation, the panel was surveyed to generate “in our practice” statements.ResultsThe SSC panel issued 93 statements: 15 best practice statements, 15 strong recommendations, and 54 weak recommendations and no recommendation was provided for 9 questions. The recommendations address several important clinical areas related to screening tools, acute resuscitation strategies, management of fluids and vasoactive agents, antimicrobials and diagnostic tests and the use of additional therapies, ventilation management, goals of care, and post sepsis care.ConclusionThe SSC panel issued evidence-based recommendations to help support key stakeholders caring for adults with sepsis or septic shock and their families.",

keywords = "Adults, evidence-based medicine, guidelines, sepsis, septic shock",

author = "Laura Evans and Andrew Rhodes and Waleed Alhazzani and Massimo Antonelli and Coopersmith, \{Craig M.\} and Craig French and MacHado, \{Fl{\'a}via R.\} and Lauralyn McIntyre and Marlies Ostermann and Prescott, \{Hallie C.\} and Christa Schorr and Steven Simpson and Wiersinga, \{W. Joost\} and Fayez Alshamsi and Angus, \{Derek C.\} and Yaseen Arabi and Luciano Azevedo and Richard Beale and Gregory Beilman and Emilie Belley-Cote and Lisa Burry and Maurizio Cecconi and John Centofanti and \{Coz Yataco\}, Angel and \{De Waele\}, Jan and Dellinger, \{R. Phillip\} and Kent Doi and Bin Du and Elisa Estenssoro and Ricard Ferrer and Charles Gomersall and Carol Hodgson and \{Hylander M{\o}ller\}, Morten and Theodore Iwashyna and Shevin Jacob and Ruth Kleinpell and Michael Klompas and Younsuck Koh and Anand Kumar and Arthur Kwizera and Suzana Lobo and Henry Masur and Steven McGloughlin and Sangeeta Mehta and Yatin Mehta and Mervyn Mer and Mark Nunnally and Simon Oczkowski and Tiffany Osborn and Elizabeth Papathanassoglou and Anders Perner and Michael Puskarich and Jason Roberts and William Schweickert and Maureen Seckel and Jonathan Sevransky and Sprung, \{Charles L.\} and Tobias Welte and Janice Zimmerman and Mitchell Levy",

year = "2021",

month = nov,

day = "1",

doi = "10.1097/ccm.0000000000005337",

language = "English",

volume = "49",

pages = "e1063--e1143",

journal = "Critical Care Medicine",

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Evans, L, Rhodes, A, Alhazzani, W, Antonelli, M, Coopersmith, CM, French, C, MacHado, FR, McIntyre, L, Ostermann, M, Prescott, HC, Schorr, C, Simpson, S, Wiersinga, WJ, Alshamsi, F, Angus, DC, Arabi, Y, Azevedo, L, Beale, R, Beilman, G, Belley-Cote, E, Burry, L, Cecconi, M, Centofanti, J, Coz Yataco, A, De Waele, J, Dellinger, RP, Doi, K, Du, B, Estenssoro, E, Ferrer, R, Gomersall, C, Hodgson, C, Hylander Møller, M, Iwashyna, T, Jacob, S, Kleinpell, R, Klompas, M, Koh, Y, Kumar, A, Kwizera, A, Lobo, S, Masur, H, McGloughlin, S, Mehta, S, Mehta, Y, Mer, M, Nunnally, M, Oczkowski, S, Osborn, T, Papathanassoglou, E, Perner, A, Puskarich, M, Roberts, J, Schweickert, W, Seckel, M, Sevransky, J, Sprung, CL, Welte, T, Zimmerman, J & Levy, M 2021, 'Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021', Critical Care Medicine, vol. 49, no. 11, pp. e1063-e1143. https://doi.org/10.1097/ccm.0000000000005337

TY - JOUR

T1 - Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

AU - Evans, Laura

AU - Rhodes, Andrew

AU - Alhazzani, Waleed

AU - Antonelli, Massimo

AU - Coopersmith, Craig M.

AU - French, Craig

AU - MacHado, Flávia R.

AU - McIntyre, Lauralyn

AU - Ostermann, Marlies

AU - Prescott, Hallie C.

AU - Schorr, Christa

AU - Simpson, Steven

AU - Wiersinga, W. Joost

AU - Alshamsi, Fayez

AU - Angus, Derek C.

AU - Arabi, Yaseen

AU - Azevedo, Luciano

AU - Beale, Richard

AU - Beilman, Gregory

AU - Belley-Cote, Emilie

AU - Burry, Lisa

AU - Cecconi, Maurizio

AU - Centofanti, John

AU - Coz Yataco, Angel

AU - De Waele, Jan

AU - Dellinger, R. Phillip

AU - Doi, Kent

AU - Du, Bin

AU - Estenssoro, Elisa

AU - Ferrer, Ricard

AU - Gomersall, Charles

AU - Hodgson, Carol

AU - Hylander Møller, Morten

AU - Iwashyna, Theodore

AU - Jacob, Shevin

AU - Kleinpell, Ruth

AU - Klompas, Michael

AU - Koh, Younsuck

AU - Kumar, Anand

AU - Kwizera, Arthur

AU - Lobo, Suzana

AU - Masur, Henry

AU - McGloughlin, Steven

AU - Mehta, Sangeeta

AU - Mehta, Yatin

AU - Mer, Mervyn

AU - Nunnally, Mark

AU - Oczkowski, Simon

AU - Osborn, Tiffany

AU - Papathanassoglou, Elizabeth

AU - Perner, Anders

AU - Puskarich, Michael

AU - Roberts, Jason

AU - Schweickert, William

AU - Seckel, Maureen

AU - Sevransky, Jonathan

AU - Sprung, Charles L.

AU - Welte, Tobias

AU - Zimmerman, Janice

AU - Levy, Mitchell

PY - 2021/11/1

Y1 - 2021/11/1

N2 - BackgroundSepsis poses a global threat to millions of lives. The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications.MethodsWe formed a panel of 60 experts from 22 countries and 11 members of the public. The panel prioritized questions that are relevant to the recognition and management of sepsis and septic shock in adults. New questions and sections were addressed, relative to the previous guidelines. These questions were grouped under 6 subgroups (screening and early treatment, infection, hemodynamics, ventilation, additional therapies, and long-term outcomes and goals of care). With input from the panel and methodologists, professional medical librarians performed the search strategy tailored to either specific questions or a group of relevant questions. A dedicated systematic review team performed screening and data abstraction when indicated. For each question, the methodologists, with input from panel members, summarized the evidence assessed and graded the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The panel generated recommendations using the evidence-to-decision framework. Recommendations were either strong or weak, or in the form of best practice statements. When evidence was insufficient to support a recommendation, the panel was surveyed to generate “in our practice” statements.ResultsThe SSC panel issued 93 statements: 15 best practice statements, 15 strong recommendations, and 54 weak recommendations and no recommendation was provided for 9 questions. The recommendations address several important clinical areas related to screening tools, acute resuscitation strategies, management of fluids and vasoactive agents, antimicrobials and diagnostic tests and the use of additional therapies, ventilation management, goals of care, and post sepsis care.ConclusionThe SSC panel issued evidence-based recommendations to help support key stakeholders caring for adults with sepsis or septic shock and their families.

AB - BackgroundSepsis poses a global threat to millions of lives. The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications.MethodsWe formed a panel of 60 experts from 22 countries and 11 members of the public. The panel prioritized questions that are relevant to the recognition and management of sepsis and septic shock in adults. New questions and sections were addressed, relative to the previous guidelines. These questions were grouped under 6 subgroups (screening and early treatment, infection, hemodynamics, ventilation, additional therapies, and long-term outcomes and goals of care). With input from the panel and methodologists, professional medical librarians performed the search strategy tailored to either specific questions or a group of relevant questions. A dedicated systematic review team performed screening and data abstraction when indicated. For each question, the methodologists, with input from panel members, summarized the evidence assessed and graded the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The panel generated recommendations using the evidence-to-decision framework. Recommendations were either strong or weak, or in the form of best practice statements. When evidence was insufficient to support a recommendation, the panel was surveyed to generate “in our practice” statements.ResultsThe SSC panel issued 93 statements: 15 best practice statements, 15 strong recommendations, and 54 weak recommendations and no recommendation was provided for 9 questions. The recommendations address several important clinical areas related to screening tools, acute resuscitation strategies, management of fluids and vasoactive agents, antimicrobials and diagnostic tests and the use of additional therapies, ventilation management, goals of care, and post sepsis care.ConclusionThe SSC panel issued evidence-based recommendations to help support key stakeholders caring for adults with sepsis or septic shock and their families.

KW - Adults

KW - evidence-based medicine

KW - guidelines

KW - sepsis

KW - septic shock

U2 - 10.1097/ccm.0000000000005337

DO - 10.1097/ccm.0000000000005337

M3 - Article

SN - 0090-3493

VL - 49

SP - e1063-e1143

JO - Critical Care Medicine

JF - Critical Care Medicine

IS - 11

ER -

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Abstract

Keywords

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