TY - JOUR

T1 - Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

AU - Weiss, Scott L.

AU - Peters, Mark J.

AU - Alhazzani, Waleed

AU - Agus, Michael S.D.

AU - Flori, Heidi R.

AU - Inwald, David P.

AU - Nadel, Simon

AU - Schlapbach, Luregn J.

AU - Tasker, Robert C.

AU - Argent, Andrew C.

AU - Brierley, Joe

AU - Carcillo, Joseph

AU - Carrol, Enitan D.

AU - Carroll, Christopher L.

AU - Cheifetz, Ira M.

AU - Choong, Karen

AU - Cies, Jeffry J.

AU - Cruz, Andrea T.

AU - De Luca, Daniele

AU - Deep, Akash

AU - Faust, Saul N.

AU - De Oliveira, Claudio Flauzino

AU - Hall, Mark W.

AU - Ishimine, Paul

AU - Javouhey, Etienne

AU - Joosten, Koen F.M.

AU - Joshi, Poonam

AU - Karam, Oliver

AU - Kneyber, Martin C.J.

AU - Lemson, Joris

AU - MacLaren, Graeme

AU - Mehta, Nilesh M.

AU - Møller, Morten Hylander

AU - Newth, Christopher J.L.

AU - Nguyen, Trung C.

AU - Nishisaki, Akira

AU - Nunnally, Mark E.

AU - Parker, Margaret M.

AU - Paul, Raina M.

AU - Randolph, Adrienne G.

AU - Ranjit, Suchitra

AU - Romer, Lewis H.

AU - Scott, Halden F.

AU - Tume, Lyvonne N.

AU - Verger, Judy T.

AU - Williams, Eric A.

AU - Wolf, Joshua

AU - Wong, Hector R.

AU - Zimmerman, Jerry J.

AU - Kissoon, Niranjan

PY - 2020

Y1 - 2020

N2 - Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods: The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, “in our practice” statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results: The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, “in our practice” statements were provided. In addition, 52 research priorities were identified. Conclusions: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.

AB - Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods: The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, “in our practice” statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results: The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, “in our practice” statements were provided. In addition, 52 research priorities were identified. Conclusions: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.

KW - Evidence-based medicine

KW - Grading of Recommendations Assessment, Development and Evaluation criteria

KW - Guidelines

KW - Infection

KW - Pediatrics

KW - Sepsis

KW - Septic shock

KW - Surviving Sepsis Campaign

UR - http://www.scopus.com/inward/record.url?scp=85079082160&partnerID=8YFLogxK

U2 - 10.1007/s00134-019-05878-6

DO - 10.1007/s00134-019-05878-6

M3 - Journal article

C2 - 32030529

AN - SCOPUS:85079082160

VL - 46

SP - 10

EP - 67

JO - European Journal of Intensive Care Medicine

JF - European Journal of Intensive Care Medicine

SN - 0935-1701

ER -