Surviving sepsis campaign: research priorities for sepsis and septic shock

doi:10.1007/s00134-018-5175-z

. 2018 Sep;44(9):1400-1426.

doi: 10.1007/s00134-018-5175-z. Epub 2018 Jul 3.

Surviving sepsis campaign: research priorities for sepsis and septic shock

Craig M Coopersmith¹, Daniel De Backer², Clifford S Deutschman^{3

4}, Ricard Ferrer^{5

6}, Ishaq Lat⁷, Flavia R Machado⁸, Greg S Martin⁹, Ignacio Martin-Loeches¹⁰, Mark E Nunnally¹¹, Massimo Antonelli¹², Laura E Evans¹³, Judith Hellman¹⁴, Sameer Jog¹⁵, Jozef Kesecioglu¹⁶, Mitchell M Levy¹⁷, Andrew Rhodes¹⁸

Affiliations

¹ Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA.
² Chirec Hospitals, Université Libre de Bruxelles, Brussels, Belgium. ddebacke@ulb.ac.be.
³ Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.
⁴ The Feinstein Institute for Medical Research/Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA.
⁵ Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.
⁶ Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca, Barcelona, Spain.
⁷ Rush University Medical Center, Chicago, IL, USA.
⁸ Universidade Federal de São Paulo, São Paulo, Brazil.
⁹ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Grady Memorial Hospital and Emory Critical Care Center, Emory University, Atlanta, GA, USA.
¹⁰ Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, Trinity Centre for Health Sciences, St James's University Hospital, Dublin, Ireland.
¹¹ New York University School of Medicine, New York, NY, USA.
¹² Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A.Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy.
¹³ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Bellevue Hospital Center and New York University School of Medicine, New York, NY, USA.
¹⁴ University of California, San Francisco, San Francisco, CA, USA.
¹⁵ Deenanath Mangeshkar Hospital and Research Center, Pune, India.
¹⁶ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁷ Rhode Island Hospital, Alpert Medical School at Brown University, Providence, RI, USA.
¹⁸ Department of Adult Critical Care, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK.

PMID: 29971592
PMCID: PMC7095388
DOI: 10.1007/s00134-018-5175-z

Surviving sepsis campaign: research priorities for sepsis and septic shock

Craig M Coopersmith et al. Intensive Care Med. 2018 Sep.

. 2018 Sep;44(9):1400-1426.

doi: 10.1007/s00134-018-5175-z. Epub 2018 Jul 3.

Authors

Affiliations

¹ Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA.
² Chirec Hospitals, Université Libre de Bruxelles, Brussels, Belgium. ddebacke@ulb.ac.be.
³ Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.
⁴ The Feinstein Institute for Medical Research/Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA.
⁵ Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.
⁶ Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca, Barcelona, Spain.
⁷ Rush University Medical Center, Chicago, IL, USA.
⁸ Universidade Federal de São Paulo, São Paulo, Brazil.
⁹ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Grady Memorial Hospital and Emory Critical Care Center, Emory University, Atlanta, GA, USA.
¹⁰ Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, Trinity Centre for Health Sciences, St James's University Hospital, Dublin, Ireland.
¹¹ New York University School of Medicine, New York, NY, USA.
¹² Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A.Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy.
¹³ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Bellevue Hospital Center and New York University School of Medicine, New York, NY, USA.
¹⁴ University of California, San Francisco, San Francisco, CA, USA.
¹⁵ Deenanath Mangeshkar Hospital and Research Center, Pune, India.
¹⁶ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁷ Rhode Island Hospital, Alpert Medical School at Brown University, Providence, RI, USA.
¹⁸ Department of Adult Critical Care, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK.

PMID: 29971592
PMCID: PMC7095388
DOI: 10.1007/s00134-018-5175-z

Abstract

Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.

Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.

Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 - supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science.

Results: The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?

Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

Keywords: Priorities; Research; Sepsis; Septic shock; Surviving Sepsis Campaign.

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Conflict of interest statement

Dr. DeBacker is immediate past president of the European Society of Intensive Care Medicine and has received consulting fees from Edwards Lifesciences, Fresenius Kabi, and Grifols. Dr. Deutschman is a consultant for Enlivix Therapeutix LTD. Dr. Ferrer Roca received honoraria from Toray, MSD, Pfizer and Grifols. Dr. Martin serves on a medical advisory board for Edwards Lifesciences and Grifols. Dr. Antonelli is president of the European Society of Intensive Care Medicine and received honoraria from Pfizer, Toray, Orion, and Air liquid. Dr. Evans is the current co-chair of the Surviving Sepsis Campaign guidelines committee. Dr. Kesecioglu is president-elect of the European Society of Intensive Care Medicine and has received honorarium from Xenios AG. Professor Rhodes is the current co-chair of the Surviving Sepsis Campaign guidelines committee.

Figures

**Fig. 1**
Flowchart identifying process of narrowing to top research questions

See this image and copyright information in PMC

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References

1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed
1. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, Angus DC, Reinhart K. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med. 2016;193:259–272. doi: 10.1164/rccm.201504-0781OC. - DOI - PubMed
1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486–552. doi: 10.1097/CCM.0000000000002255. - DOI - PubMed
1. Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, Osborn T, Lemeshow S, Chiche JD, Artigas A, Dellinger RP. Surviving sepsis campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015;43:3–12. doi: 10.1097/CCM.0000000000000723. - DOI - PubMed
1. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, Schorr C, Artigas A, Ramsay G, Beale R, Parker MM, Gerlach H, Reinhart K, Silva E, Harvey M, Regan S, Angus DC. The surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38:367–374. doi: 10.1097/CCM.0b013e3181cb0cdc. - DOI - PubMed

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[1] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed

[2] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed

[3] Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, Angus DC, Reinhart K. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med. 2016;193:259–272. doi: 10.1164/rccm.201504-0781OC. - DOI - PubMed

[4] Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, Angus DC, Reinhart K. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med. 2016;193:259–272. doi: 10.1164/rccm.201504-0781OC. - DOI - PubMed

[5] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486–552. doi: 10.1097/CCM.0000000000002255. - DOI - PubMed

[6] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486–552. doi: 10.1097/CCM.0000000000002255. - DOI - PubMed

[7] Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, Osborn T, Lemeshow S, Chiche JD, Artigas A, Dellinger RP. Surviving sepsis campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015;43:3–12. doi: 10.1097/CCM.0000000000000723. - DOI - PubMed

[8] Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, Osborn T, Lemeshow S, Chiche JD, Artigas A, Dellinger RP. Surviving sepsis campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015;43:3–12. doi: 10.1097/CCM.0000000000000723. - DOI - PubMed

[9] Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, Schorr C, Artigas A, Ramsay G, Beale R, Parker MM, Gerlach H, Reinhart K, Silva E, Harvey M, Regan S, Angus DC. The surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38:367–374. doi: 10.1097/CCM.0b013e3181cb0cdc. - DOI - PubMed

[10] Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, Schorr C, Artigas A, Ramsay G, Beale R, Parker MM, Gerlach H, Reinhart K, Silva E, Harvey M, Regan S, Angus DC. The surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38:367–374. doi: 10.1097/CCM.0b013e3181cb0cdc. - DOI - PubMed

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Surviving sepsis campaign: research priorities for sepsis and septic shock

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Surviving sepsis campaign: research priorities for sepsis and septic shock

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