Sepsis Campaing 2012 Guia Completa

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 Committeeincluding the Pediatric 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 membersattending the conference). 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 entirecommittee
served as an integral part of the development.

Methods: The authors were advised to follow the principles of the
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 strongrecommendations 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

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-KlinikumNeukölln, 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.

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...