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

Abstract

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.

Keywords

Affiliated Institutions

• Children's Hospital Colorado US
• Great Ormond Street Hospital GB
• Harvard University US
• Assistance Publique – Hôpitaux de Paris FR
• Red Cross War Memorial Children's Hospital ZA
• St. Christopher's Hospital for Children US
• University College London GB
• Texas Children's Hospital US
• Johns Hopkins Children's Center US
• Institut de Biologie Intégrative de la Cellule FR
• University of Pennsylvania US
• Queensland Children’s Hospital AU
• Latin American Sepsis Institute BR
• Rigshospitalet DK
• Seattle Children's Hospital US
• Centre National de la Recherche Scientifique FR
• The University of Queensland AU
• National University Health System SG
• University of Iowa US
• Philadelphia University US
• Nationwide Children's Hospital US
• University of Cape Town ZA
• Children's Hospital of Los Angeles US
• NYU Langone Health US
• Cincinnati Children's Hospital Medical Center US
• University of Colorado Denver US
• Advocate Children's Hospital US
• Connecticut Children's Medical Center US
• Université Paris-Saclay FR
• Commissariat à l'Énergie Atomique et aux Énergies Alternatives FR
• Impact CA
• King's College Hospital GB
• Boston Children's Hospital US
• Royal Children's Hospital AU
• Hôpital Lyon Sud FR
• BC Children's Hospital CA
• Children's Hospital of Pittsburgh US
• University Hospital Southampton NHS Foundation Trust GB
• C. S. Mott Children's Hospital US
• University of Liverpool GB
• University of the West of England GB
• Beatrix Kinderziekenhuis NL
• St. Jude Children's Research Hospital US
• Erasmus MC NL
• All India Institute of Medical Sciences IN
• University of Southampton GB
• Children's Hospital of Philadelphia US
• Duke Children's Hospital & Health Center US
• Inserm FR
• St Mary's Hospital GB
• St. Mary's Hospital GB
• McMaster University CA
• Johns Hopkins University US
• Children's Hospital of Richmond at VCU US
• Rady Children's Hospital-San Diego US
• Radboud University Medical Center NL
• Stony Brook University US
• Apollo Hospitals IN
• Radboud University Nijmegen NL

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