title: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
abstract: OBJECTIVE
  To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".
  
  
  METHODS
  A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development.
  
  
  METHODS
  The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.
  
  
  RESULTS
  The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions.
  
  
  CONCLUSIONS
  Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
authors.affiliation: St. George's Hospital, London, England, UK. andrewrhodes@nhs.net.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rhodes
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Evans
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Waleed
authors.initials: W
authors.lastname: Alhazzani
authors.affiliation: Brown University School of Medicine, Providence, RI, USA.
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Levy
authors.affiliation: Instituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.affiliation: Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Ferrer
authors.affiliation: University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Anand
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Emory University Hospital, Atlanta, GA, USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Sevransky
authors.affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Nunnally
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Bram
authors.initials: B
authors.lastname: Rochwerg
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.affiliation: University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.affiliation: Hospital Raymond Poincare, Garches, France.
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.affiliation: Saint Thomas Hospital, London, England, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Beale
authors.affiliation: University College London Hospitals, London, England, UK.
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Bellinghan
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bernard
authors.affiliation: Service de Reanimation Medicale, Paris, France.
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.affiliation: Emory University Hospital, Atlanta, GA, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Coopersmith
authors.affiliation: CHIREC Hospitals, Braine L'Alleud, Belgium.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: De Backer
authors.affiliation: Western Hospital, Victoria, Australia.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: French
authors.affiliation: Keio University School of Medicine, Tokyo, Japan.
authors.forename: Seitaro
authors.initials: S
authors.lastname: Fujishima
authors.affiliation: Vivantes-Klinikum Neukölln, Berlin, Germany.
authors.forename: Herwig
authors.initials: H
authors.lastname: Gerlach
authors.affiliation: Karl Heusner Memorial Hospital, Belize Healthcare Partners, Belize City, Belize.
authors.forename: Jorge Luis
authors.initials: JL
authors.lastname: Hidalgo
authors.affiliation: Cooper Health System, Camden, NJ, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Hollenberg
authors.affiliation: University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
authors.affiliation: Jupiter Hospital, Thane, India.
authors.forename: Dilip R
authors.initials: DR
authors.lastname: Karnad
authors.affiliation: Rush University Medical Center, Chicago, IL, USA.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Kleinpell
authors.affiliation: ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Younsuk
authors.initials: Y
authors.lastname: Koh
authors.affiliation: Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Thiago Costa
authors.initials: TC
authors.lastname: Lisboa
authors.affiliation: Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Flavia R
authors.initials: FR
authors.lastname: Machado
authors.affiliation: Regions Hospital, St. Paul, MN, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Marini
authors.affiliation: Saint Michael's Hospital, Toronto, ON, Canada.
authors.forename: John C
authors.initials: JC
authors.lastname: Marshall
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Mazuski
authors.affiliation: Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Lauralyn A
authors.initials: LA
authors.lastname: McIntyre
authors.affiliation: Nepean Hospital, University of Sydney, Penrith, NSW, Australia.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: McLean
authors.affiliation: Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.affiliation: UCINC, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: Rui P
authors.initials: RP
authors.lastname: Moreno
authors.affiliation: University of New South Wales, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.affiliation: Università dellla Magna Graecia, Catanzaro, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Navalesi
authors.affiliation: Fujita Health University School of Medicine, Toyoake, Aich, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishida
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Tiffany M
authors.initials: TM
authors.lastname: Osborn
authors.affiliation: Rigshospitalet, Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Perner
authors.affiliation: Rush University Medical Center, Chicago, IL, USA.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Plunkett
authors.affiliation: Università Sapienza, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranieri
authors.affiliation: Cooper Health System, Camden, NJ, USA.
authors.forename: Christa A
authors.initials: CA
authors.lastname: Schorr
authors.affiliation: Christiana Care Health Services, Newark, DE, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Seckel
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seymour
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Shieh
authors.affiliation: Kaust Medical Services, Thuwal, Saudi Arabia.
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Shukri
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Steven Q
authors.initials: SQ
authors.lastname: Simpson
authors.affiliation: Wolfson Institute of Biomedical Research, London, England, UK.
authors.forename: Mervyn
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authors.lastname: Singer
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.affiliation: California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Sean R
authors.initials: SR
authors.lastname: Townsend
authors.affiliation: University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Thomas
authors.initials: T
authors.lastname: Van der Poll
authors.affiliation: Erasmé University Hospital, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: University of Amsterdam, Amsterdam, Netherlands.
authors.forename: W Joost
authors.initials: WJ
authors.lastname: Wiersinga
authors.affiliation: Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Janice L
authors.initials: JL
authors.lastname: Zimmerman
authors.affiliation: Cooper Health System, Camden, NJ, USA.
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001786:Blood Glucose; D002116:Calcitonin / Q000097:blood; D016638:Critical Illness / Q000628:therapy; D017707:Erythrocyte Transfusion; D005440:Fluid Therapy; D006801:Humans; D015596:Nutrition Assessment; D010347:Patient Care Planning; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy*; D012772:Shock, Septic / Q000175:diagnosis / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D014662:Vasoconstrictor Agents; D002116:Calcitonin
keywords: Evidence-based medicine; Grading of Recommendations Assessment, Development, and Evaluation criteria; Guidelines; Infection; Sepsis; Sepsis bundles; Sepsis syndrome; Septic shock; Surviving Sepsis Campaign