guidelines
European management
guidelines
Treatment guidelines convert the large amounts of data in the literature,
often complex and seemingly overwhelming, into digestible information that can be
more easily implemented when dealing with challenges in clinical practice
Jordi Rello MD PhD
Hospital Vall d’Hebron,
Barcelona, Spain
A large body of evidence has been accumulating
since the first guidelines for the management of
sepsis and septic shock were issued by the
European Society of Intensive Care Medicine
(ESICM) in 2004. Together with the Society of
Critical Care Medicine (SCCM), the ESICM created
the Surviving Sepsis Campaign (SSC) to provide
guidance for healthcare professionals in regard to
the best practices in the care of these patients.
The SSC has as main objectives to build awareness
of the condition and its complications, improve
early diagnosis, educate the medical teams about
the most effective approaches, periodically issue
guidelines for adequate management and
treatment, including care after patients are
discharged from intensive care units, and
implement performance improvement programs
at the individual institutions. 1,2
Following revisions in 2008 and 2012, the
International guidelines published in 2016
incorporated the new definitions of sepsis and
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HHE 2018 | hospitalhealthcare.com
septic shock proposed by the Third International
Consensus Definitions for Sepsis and Septic Shock
(Sepsis-3 ). Sepsis was thus defined as life-
threatening organ dysfunction resulting from an
abnormal response of the body to an infective
agent, which can be accompanied by circulatory
and cellular and metabolic disruption in septic
shock. These 2016 guidelines were based on the
most recent evidence on initial resuscitation,
screening and diagnosis, where the significant
changes were made. The treatment
recommendations for adults with sepsis or septic
shock addressed antimicrobial therapy, source
control, glucose control and fluid therapy, as well
as the administration of vasoactive medications,
corticosteroids, blood products, and
immunoglobulins. The revised practice guidelines
also tackled the use of blood purification methods
and anticoagulation, mechanical ventilation,
sedation and analgesia, and renal replacement.
Prophylactic measures for complications such
as venous thromboembolism and stress ulcers,
as well as nutrition, were also covered. 3
Although the level of the quality of the
evidence and the strength of the
recommendations have changed and will change
throughout the years, the goals of care
remain essentially unchanged. The
multidisciplinary medical care
team should discuss these
goals, which should
include palliation
when needed, with
patients and
their family