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Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children

Scott L. WeissChildren’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PAMark PetersGreat Ormond Street Hospital for Children, London, United KingdomWaleed AlhazzaniDepartment of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, CanadaMichael S. D. AgusDepartment of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children’s Hospital and Harvard Medical School, Boston, MAHeidi R. FloriC.S. Mott Children’s Hospital, Ann Arbor, MIDavid InwaldSt. Mary’s Hospital, London, United KingdomSimon NadelSt. Mary’s Hospital, London, United KingdomLuregn J. SchlapbachPaediatric Critical Care Research Group, The University of Queensland and Queensland Children’s Hospital, Brisbane, QLD, AustraliaRobert C. TaskerDepartment of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children’s Hospital and Harvard Medical School, Boston, MAAndrew C. ArgentRed Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South AfricaJoe BrierleyGreat Ormond Street Hospital for Children, London, United KingdomJoseph A. CarcilloChildren’s Hospital of Pittsburgh, Pittsburgh, PAEnitan D. CarrolUniversity of Liverpool, Liverpool, United KingdomChristopher L. CarrollConnecticut Children’s Medical Center, Hartford, CTIra M. CheifetzDuke Children’s, Durham, NCKaren ChoongDepartment of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, CanadaJeffry J. CiesSt. Christopher’s Hospital for Children, Philadelphia, PAAndrea T. CruzTexas Children’s Hospital, Houston, TXDanièle De LucaParis South University Hospitals—Assistance Publique Hopitaux de Paris, Paris, FranceAkash DeepKing’s College Hospital, London, United KingdomSaul N. FaustUniversity Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United KingdomCláudio Flauzino de OliveiraThe Latin America Sepsis Institute, São Paulo, BrazilMark W. HallNationwide Children’s Hospital, Columbus, OHPaul IshimineRady Children’s Hospital, San Diego, CAÉtienne JavouheyCentre Hospitalier Universitaire de Lyon, Lyon, FranceKoen JoostenErasmus University Medical Center, Rotterdam, The NetherlandsPoonam JoshiAll India Institute of Medical Sciences, New Delhi, IndiaOliver KaramChildren’s Hospital of Richmond at VCU, Richmond, VAMartin C. J. KneyberBeatrix Children’s Hospital, Groningen, The NetherlandsJoris LemsonRadboud University Medical Centre, Nijmegen, The NetherlandsGraeme MacLarenNational University Health System, Singapore, and Royal Children’s Hospital, Melbourne, VIC, AustraliaNilesh M. MehtaDepartment of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children’s Hospital and Harvard Medical School, Boston, MAMorten Hylander MøllerRigshospitalet Hospital, Copenhagen, DenmarkChristopher J. L. NewthChildren’s Hospital of Los Angeles, Los Angeles, CATrung NguyenTexas Children’s Hospital, Houston, TXAkira NishisakiChildren’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PAMark NunnallyNew York University Langone Medical Center, New York, NYMargaret M. ParkerStony Brook University, Stony Brook, NYRaina PaulAdvocate Children’s Hospital, Park Ridge, ILAdrienne G. RandolphDepartment of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children’s Hospital and Harvard Medical School, Boston, MASuchitra RanjitApollo Hospitals, Chennai, IndiaLewis H. RomerJohns Hopkins Children’s Center, Baltimore, MDHalden F. ScottChildren’s Hospital Colorado, Aurora, COLyvonne N. TumeUniversity of the West of England, Bristol, United KingdomJudy VergerPhiladelphia UniversityEric A. WilliamsTexas Children’s Hospital, Houston, TXJoshua WolfSt. Jude Children’s Research Hospital, Memphis, TNHector R. WongCincinnati Children’s Hospital, Cincinnati, OHJerry J. ZimmermanSeattle Children’s Hospital, Seattle, WANiranjan KissoonBritish Columbia Children’s Hospital, Vancouver, British Columbia, CanadaPierre TissièresInstitute of Integrative Biology of the Cell-CNRS, CEA, Univ Paris Sud, Gif-sur-Yvette, France

2020en

ABI

Annotatsiya

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, 52 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, 49 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.

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DOI: 10.1097/pcc.0000000000002198

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