Superviviendo A La Sepsis

Special Articles

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012
R. Phillip Dellinger, MD1; Mitchell M. Levy, MD2; Andrew Rhodes, MB BS3; Djillali Annane, MD4; Herwig Gerlach, MD, PhD5; Steven M. Opal, MD6; Jonathan E. Sevransky, MD7; Charles L. Sprung, MD8; Ivor S. Douglas, MD9; Roman Jaeschke, MD10; Tiffany M. Osborn, MD, MPH11;Mark E. Nunnally, MD12; Sean R. Townsend, MD13; Konrad Reinhart, MD14; Ruth M. Kleinpell, PhD, RN-CS15; Derek C. Angus, MD, MPH16; Clifford S. Deutschman, MD, MS17; Flavia R. Machado, MD, PhD18; Gordon D. Rubenfeld, MD19; Steven A. Webb, MB BS, PhD20; Richard J. Beale, MB BS21; Jean-Louis Vincent, MD, PhD22; Rui Moreno, MD, PhD23; and the Surviving Sepsis Campaign Guidelines Committee including thePediatric Subgroup*

Objective: To provide an update to the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” last published in 2008. Design: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending theconference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee servedas an integral part of the development.
Cooper University Hospital, Camden, New Jersey. Warren Alpert Medical School of Brown University, Providence, Rhode Island. 3 St. George’s Hospital, London, United Kingdom. 4 Hôpital Raymond Poincaré, Garches, France. 5 Vivantes-Klinikum Neukölln, Berlin, Germany. 6 Memorial Hospital of Rhode Island, Pawtucket, Rhode Island. 7 Emory University Hospital,Atlanta, Georgia. 8 Hadassah Hebrew University Medical Center, Jerusalem, Israel. 9 Denver Health Medical Center, Denver, Colorado. 10 McMaster University, Hamilton, Ontario, Canada. 11 Barnes-Jewish Hospital, St. Louis, Missouri. 12 University of Chicago Medical Center, Chicago, Illinois. 13 California Pacific Medical Center, San Francisco, California. 14 Friedrich Schiller University Jena, Jena,Germany. 15 Rush University Medical Center, Chicago, Illinois. 16 University of Pittsburgh, Pittsburgh, Pennsylvania. 17 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 18 Federal University of Sao Paulo, Sao Paulo, Brazil. 19 Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
1 2

Methods: The authors were advised to follow the principles ofthe Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of lowquality evidence were emphasized. Some recommendations were ungraded (UG).Recommendations were classified into three groups: 1) those directly targeting severe sepsis; 2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and 3) pediatric considerations. Results: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 hrs after recognition(1C); blood cultures
Royal Perth Hospital, Perth, Western Australia. Guy’s and St. Thomas’ Hospital Trust, London, United Kingdom. 22 Erasme University Hospital, Brussels, Belgium. 23 UCINC, Hospital de São José, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal. * Members of the 2012 SSC Guidelines Committee and Pediatric Subgroup are listed in Appendix A at the end of this article....