Surviving sepsis 2008

Special Article

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008
R. Phillip Dellinger, MD; Mitchell M. Levy, MD; Jean M. Carlet, MD;Julian Bion, MD; Margaret M. Parker, MD; Roman Jaeschke, MD; Konrad Reinhart, MD; Derek C. Angus, MD, MPH; Christian Brun-Buisson, MD; Richard Beale, MD; Thierry Calandra, MD, PhD; Jean-Francois Dhainaut,MD; Herwig Gerlach, MD; Maurene Harvey, RN; John J. Marini, MD; John Marshall, MD; Marco Ranieri, MD; Graham Ramsay, MD; Jonathan Sevransky, MD; B. Taylor Thompson, MD; Sean Townsend, MD; Jeffrey S.Vender, MD; Janice L. Zimmerman, MD; Jean-Louis Vincent, MD, PhD; for the International Surviving Sepsis Campaign Guidelines Committee
Objective: To provide an update to the original Surviving SepsisCampaign clinical management guidelines, “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” published in 2004. Design: Modified Delphi method with a consensusconference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. Thisprocess was conducted independently of any industry funding. Methods: We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to guide assessment of quality ofevidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation (1) indicates that an intervention’s desirable effects clearly outweigh its undesirableeffects (risk, burden, cost) or clearly do not. Weak recommendations (2) indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered ofgreater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations...