Quality of evidence supporting Surviving Sepsis Campaign Recommendations - 02/08/20

Doi : 10.1016/j.accpm.2020.06.015

Jordi Rello ^a,^b,^c,^{^{1
JR and ST contributed equally as first author.}}, Sofia Tejada ^a,^b,⁎, ^{^{1
JR and ST contributed equally as first author.}} , Elena Xu ^d, Candela Solé-Lleonart ^e, Laura Campogiani ^f, Despoina Koulenti ^d,^g, João Ferreira-Coimbra ^h, Jeff Lipman ^c,^d
^a Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d’Hebron Institut of Research (VHIR), Barcelona, Spain
^b Centro de Investigacion Biomedica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
^c Scientifical Research, CHU Nîmes, University Montpellier-Nîmes, Nîmes, France
^d UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
^e Intensive Care Unit. Hospital Universitari de Vic, Barcelona, Spain
^f Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, Rome, Italy
^g Department of Critical Care II, Attikon University Hospital, Athens, Greece
^h Internal Medicine Department, Centro Hospitalar Universitário do Porto, Porto, Portugal

^⁎Corresponding author. CIBERES - Vall d’Hebron Institut de Recerca, Clinical Research/epidemiology In Pneumonia & Sepsis (CRIPS), Ps. Vall d’Hebron 119 - AMI 14th floor, 08035 Barcelona, Spain.CIBERES - Vall d’Hebron Institut de Recerca, Clinical Research/epidemiology In Pneumonia & Sepsis (CRIPS)Ps. Vall d’Hebron 119 - AMI 14th floorBarcelona08035Spain

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Sunday 02 August 2020
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Abstract

Introduction

The Surviving Sepsis Campaign (SSC) guidelines, released in 2017, are a combination of expert opinion and evidence-based medicine, adopted by many institutions as a standard of practice. The aim was to analyse the quality of evidence supporting recommendations on the management of sepsis.

Methods

The strength and quality of evidence (high, moderate, low-very low and best practice statements) of each recommendation were extracted. Randomised controlled trials were required to qualify as high-quality evidence.

Results

A total of 96 recommendations were formulated, and 87 were included. Among thirty-one (43%) strong recommendations, only 15.2% were supported by high-quality evidence. Overall, thirty-seven (42.5%) recommendations were based on low-quality evidence, followed by 28 (32.2%) based on moderate-quality, 15 (17.2%) were best practice statements and only seven (8.0%) were supported by high-quality evidence. Randomised controlled trials supported 21.4%, 9.5% and 8.6% recommendations on mechanical ventilation, resuscitation, and management/adjuvant therapy, respectively. In contrast, none high-quality evidence recommendation supported antimicrobial/source control (82.4% were low-very low evidence or best practice statements), and nutrition.

Conclusions

In the SSC guidelines most recommendations were informed by indirect evidence and non-systematic observations. While awaiting trials results, Delphi-like approaches or multi-criteria decision analyses should guide recommendations.

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Keywords : Antimicrobial administration, Haemodynamic resuscitation, Mechanical ventilation, Clinical practice guidelines, Septic shock

Abbreviations : ARDS, BPS, CPG, GRADE, LOE, MCDA, PRISMA, RCT, SCC, WHO