Quality of evidence supporting Surviving Sepsis Campaign Recommendations - 19/08/20
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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.
El texto completo de este artículo está disponible en PDF.Keywords : Antimicrobial administration, Haemodynamic resuscitation, Mechanical ventilation, Clinical practice guidelines, Septic shock
Abbreviations : ARDS, BPS, CPG, GRADE, LOE, MCDA, PRISMA, RCT, SCC, WHO
Esquema
Vol 39 - N° 4
P. 497-502 - août 2020 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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