Surviving sepsis campaign guidelines 2021: “eight pitfalls” in early resuscitation

doi:10.3877/cma.j.issn.2096-1537.2023.01.003

Abstract

Abstract:

The surviving sepsis campaign (SSC) guidelines has been updated five editions nowadays since it first published in 2004. SSC guidelines promote knowledge about sepsis constantly, which also improve management of sepsis to a certain extent, and become an important basis for guiding diagnosis and therapy in patients with sepsis. However, there are still several obvious defects in early resuscitation of septic shock in the SSC guidelines 2021, and the relevant recommendations may lead to misinterpretation or misuse. Therefore, "eight pitfalls" and relevant clinical evidence in SSC guidelines 2021 are discussed in present commentary.

Key words: Surviving sepsis campaign, Early resuscitation, Evidence-based medicine

Zongsheng Wu, Jianfeng Xie, Haibo Qiu. Surviving sepsis campaign guidelines 2021: “eight pitfalls” in early resuscitation[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 14-18.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2023.01.003

https://icu.cma-cmc.com.cn/EN/Y2023/V09/I01/14

References 33

1	Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 [J]. Intensive Care Med, 2021, 47(11): 1181-1247.
2	Dellinger RP, Carlet JM, Masur H, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock [J]. Crit Care Med, 2004, 32(3): 858-873.
3	Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock [J]. N Engl J Med, 2014, 370(18): 1683-1693.
4	Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock [J]. N Engl J Med, 2014, 371(16): 1496-1506.
5	Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock [J]. N Engl J Med, 2015, 372(14): 1301-1311.
6	Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock [J]. N Engl J Med, 2001, 345(19): 1368-1377.
7	Andrews B, Semler MW, Muchemwa L, et al. Effect of an early resuscitation protocol on in-hospital mortality among adults with sepsis and hypotension: a randomized clinical trial [J]. JAMA, 2017, 318(13): 1233-1240.
8	Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence [J]. Chest, 2002, 121(6): 2000-2008.
9	Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012 [J]. Crit Care Med, 2013, 41(2): 580-637.
10	Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 [J]. Crit Care Med, 2017, 45(3): 486-552.
11	Bai X, Yu W, Ji W, et al. Early versus delayed administration of norepinephrine in patients with septic shock [J]. Crit Care, 2014, 18(5): 532.
12	Colon Hidalgo D, Patel J, Masic D, et al. Delayed vasopressor initiation is associated with increased mortality in patients with septic shock [J]. J Crit Care, 2020, 55: 145-148.
13	Waechter J, Kumar A, Lapinsky SE, et al. Interaction between fluids and vasoactive agents on mortality in septic shock: a multicenter, observational study [J]. Crit Care Med, 2014, 42(10): 2158-2168.
14	Ospina-Tascón GA, Hernandez G, Alvarez I, et al. Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis [J]. Crit Care, 2020, 24(1): 52.
15	Spiegel R. Stressed vs. unstressed volume and its relevance to critical care practitioners [J]. Clin Exp Emerg Med, 2016, 3(1): 52-54.
16	Schellenberg M, Cobb JP. Fluid resuscitation and vasopressors in septic shock: the importance of filling the tank while squeezing the pipes [J]. Crit Care Med, 2020, 48(10): 1533-1535.
17	Conrad M, Perez P, Thivilier C, et al. Early prediction of norepinephrine dependency and refractory septic shock with a multimodal approach of vascular failure [J]. J Crit Care, 2015, 30(4): 739-743.
18	Monge García MI, Pinsky MR, Cecconi M. Predicting vasopressor needs using dynamic parameters [J]. Intensive Care Med, 2017, 43(12): 1841-1843.
19	García MI, Romero MG, Cano AG, et al. Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: a validation study [J]. Crit Care, 2014, 18(6): 626.
20	Guinot PG, Abou-Arab O, Guilbart M, et al. Monitoring dynamic arterial elastance as a means of decreasing the duration of norepinephrine treatment in vasoplegic syndrome following cardiac surgery: a prospective, randomized trial [J]. Intensive Care Med, 2017, 43(5): 643-651.
21	Hernández G, Teboul JL. Fourth Surviving Sepsis Campaign's hemodynamic recommendations: a step forward or a return to chaos? [J]. Crit Care, 2017, 21(1): 133.
22	Jean-Louis Teboul OH. Early hemodynamic resuscitation of septic shock: what do the new Surviving Sepsis Campaign guidelines really provide? [J]. J Intensive Med, 2022, 1(2): 1-2.
23	Dunser MW, Takala J, Ulmer H, et al. Arterial blood pressure during early sepsis and outcome [J]. Intensive Care Med, 2009, 35(7): 1225-1233.
24	Xu JY, Ma SQ, Pan C, et al. A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study [J]. Crit Care, 2015, 19(1): 130.
25	Kato R, Pinsky MR. Personalizing blood pressure management in septic shock [J]. Ann Intensive Care, 2015, 5(1): 41.
26	Pope JV, Jones AE, Gaieski DF, et al. Multicenter study of central venous oxygen saturation (ScvO(2)) as a predictor of mortality in patients with sepsis [J]. Ann Emerg Med, 2010, 55(1): 40-46.e1.
27	Pino RM, Singh J. Appropriate clinical use of lactate measurements [J]. Anesthesiology, 2021, 134(4): 637-644.
28	Haas SA, Lange T, Saugel B, et al. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients [J]. Intensive Care Med, 2016, 42(2): 202-210.
29	Tongyoo S, Sutthipool K, Viarasilpa T, et al. Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock [J]. Acute Crit Care, 2022, 37(1): 108-117.
30	Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial [J]. JAMA, 2010, 303(8): 739-746.
31	Hernandez G, Luengo C, Bruhn A, et al. When to stop septic shock resuscitation: clues from a dynamic perfusion monitoring [J]. Ann Intensive Care, 2014, 4: 30.
32	Lima A, Jansen TC, Van Bommel J, et al. The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients [J]. Crit Care Med, 2009, 37(3): 934-948.
33	Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the andromeda-shock randomized clinical trial [J]. JAMA, 2019, 321(7): 654-664.

[1]	Tianzhu Long, Yuzhi Yao, Jiayue Luo, Yuanxuan Cai, Zhen Liang, Zhe Fan, Cairong Zhu, Yuhong Pan, Hongmin Ma. Antibiotic treatment for lactational breast abscess: a retrospective study [J]. Chinese Journal of Breast Disease(Electronic Edition), 2021, 15(04): 214-217.
[2]	Xiaowei Qi, Xiaoyu Wang, Yanling Li, Ying Hu, Wenting Yan, Long Yuan, Xuanni Tan, Qinwen Pan, Lin Ren, Ling Zhong, Qingqiu Chen, Ting Zhang, Kongyong Zhang, Jun Jiang. Application of evidence-based medicine in undergraduate education to improve scientific research ability [J]. Chinese Journal of Breast Disease(Electronic Edition), 2018, 12(02): 100-103.
[3]	The Joint Surgery Branch of the Chinese Orthopaedic Association, 920th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army. Chinese clinical practice guidelines for total hip arthroplasty approach selection (2021 edition) [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(06): 651-659.
[4]	Dan Xing, Jianhao Lin. Real-world research in developing clinical practice guidelines for osteoarthritis [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(01): 91-95.
[5]	Chunsong Yang, Lingli Zhang, Hong Huang, Cairong Zhu. Research progress on antiepileptic drugs in the treatment of Tourette's syndrome in children [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2015, 11(03): 407-410.
[6]	Haiwei Wu, Jiawei Zheng. Evidence-based treatment algorithms for vascular malformations of the head and neck [J]. Chinese Journal of Stomatological Research(Electronic Edition), 2016, 10(04): 231-237.
[7]	Qian Liu. The clinical status of lateral lymph node dissection for rectal cancer in China [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(05): 367-371.
[8]	Ying Zheng, Jinling Meng, Guangyan Cai, Zhe Feng. Practice and thinking of blended learning mode in evidence-based medicine course for professional degree postgraduates in nephrology [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(01): 48-50.
[9]	Li Zhang. Exploration of multidimensional teaching of clinical practice guidelines for kidney disease [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(02): 78-81.
[10]	Hongyu Yang, Jicheng Lv, Hong Zhang. Status of research on endocapillary proliferation lesion in IgA nephropathy [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2016, 05(05): 232-237.
[11]	Yachun Han, Lin Sun. New advancements of evidenced-based medical treatment of diabetic nephropathy [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2015, 04(05): 251-256.
[12]	Dechang Chen. From the past to the present and the future: the 20 anniversary of the establishment of the Chinese Society of Critical Care Medicine [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(03): 145-148.
[13]	Jinquan Wang. Clinical thinking in the treatment of critically ill patients [J]. Chinese Journal of Diagnostics(Electronic Edition), 2017, 05(01): 42-45.
[14]	Dong Wu. Clinical thinking and its dynamic characteristics [J]. Chinese Journal of Diagnostics(Electronic Edition), 2015, 03(02): 90-97.
[15]	Xiaoling Wang, Ting Yang, Zhuanye Yin, Ying Zhang. Evidence summary of identification and prevention of post-stroke depression [J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(01): 51-56.

Please choose a citation manager

Content to export