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. 2025 Feb 24;12(1):e70037.
doi: 10.1002/ams2.70037. eCollection 2025 Jan-Dec.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024

Nobuaki Shime  1 , Taka-Aki Nakada  2 , Tomoaki Yatabe  3 , Kazuma Yamakawa  4 , Yoshitaka Aoki  5 , Shigeaki Inoue  6 , Toshiaki Iba  7 , Hiroshi Ogura  8 , Yusuke Kawai  9 , Atsushi Kawaguchi  10 , Tatsuya Kawasaki  11 , Yutaka Kondo  12 , Masaaki Sakuraya  13 , Shunsuke Taito  14 , Kent Doi  15 , Hideki Hashimoto  16 , Yoshitaka Hara  17 , Tatsuma Fukuda  18 , Asako Matsushima  19 , Moritoki Egi  20 , Shigeki Kushimoto  21 , Takehiko Oami  2 , Kazuya Kikutani  1 , Yuki Kotani  22 , Gen Aikawa  23 , Makoto Aoki  24 , Masayuki Akatsuka  25 , Hideki Asai  26 , Toshikazu Abe  27 , Yu Amemiya  4 , Ryo Ishizawa  28 , Tadashi Ishihara  12 , Tadayoshi Ishimaru  29 , Yusuke Itosu  30 , Hiroyasu Inoue  31 , Hisashi Imahase  32 , Haruki Imura  33 , Naoya Iwasaki  34 , Noritaka Ushio  4 , Masatoshi Uchida  35 , Michiko Uchi  36 , Takeshi Umegaki  37 , Yutaka Umemura  38 , Akira Endo  39 , Marina Oi  40 , Akira Ouchi  23 , Itsuki Osawa  15 , Yoshiyasu Oshima  41 , Kohei Ota  1 , Takanori Ohno  42 , Yohei Okada  43 , Hiromu Okano  44 , Yoshihito Ogawa  38 , Masahiro Kashiura  45 , Daisuke Kasugai  46 , Ken-Ichi Kano  47 , Ryo Kamidani  48 , Akira Kawauchi  49 , Sadatoshi Kawakami  50 , Daisuke Kawakami  51 , Yusuke Kawamura  52 , Kenji Kandori  53 , Yuki Kishihara  45 , Sho Kimura  54 , Kenji Kubo  55   56 , Tomoki Kuribara  57 , Hiroyuki Koami  58 , Shigeru Koba  59 , Takehito Sato  60 , Ren Sato  61 , Yusuke Sawada  62 , Haruka Shida  63 , Tadanaga Shimada  2 , Motohiro Shimizu  64 , Kazushige Shimizu  65 , Takuto Shiraishi  66 , Toru Shinkai  67 , Akihito Tampo  68 , Gaku Sugiura  49 , Kensuke Sugimoto  69 , Hiroshi Sugimoto  70 , Tomohiro Suhara  71 , Motohiro Sekino  34 , Kenji Sonota  72 , Mahoko Taito  73 , Nozomi Takahashi  74 , Jun Takeshita  75 , Chikashi Takeda  20 , Junko Tatsuno  76 , Aiko Tanaka  77 , Masanori Tani  78 , Atsushi Tanikawa  21 , Hao Chen  79 , Takumi Tsuchida  30 , Yusuke Tsutsumi  80 , Takefumi Tsunemitsu  43 , Ryo Deguchi  81 , Kenichi Tetsuhara  82 , Takero Terayama  83 , Yuki Togami  84 , Takaaki Totoki  85 , Yoshinori Tomoda  86 , Shunichiro Nakao  8 , Hiroki Nagasawa  87 , Yasuhisa Nakatani  88 , Nobuto Nakanishi  89 , Norihiro Nishioka  42 , Mitsuaki Nishikimi  1 , Satoko Noguchi  90 , Suguru Nonami  91 , Osamu Nomura  92 , Katsuhiko Hashimoto  93 , Junji Hatakeyama  4 , Yasutaka Hamai  43 , Mayu Hikone  94 , Ryo Hisamune  4 , Tomoya Hirose  8 , Ryota Fuke  95 , Ryo Fujii  96 , Naoki Fujie  97 , Jun Fujinaga  98 , Yoshihisa Fujinami  99 , Sho Fujiwara  100   101 , Hiraku Funakoshi  102 , Koichiro Homma  103 , Yuto Makino  43 , Hiroshi Matsuura  104 , Ayaka Matsuoka  58 , Tadashi Matsuoka  103 , Yosuke Matsumura  105 , Akito Mizuno  20 , Sohma Miyamoto  106 , Yukari Miyoshi  12 , Satoshi Murata  107 , Teppei Murata  108 , Hiromasa Yakushiji  109 , Shunsuke Yasuo  110 , Kohei Yamada  111 , Hiroyuki Yamada  112 , Ryo Yamamoto  103 , Ryohei Yamamoto  113 , Tetsuya Yumoto  114 , Yuji Yoshida  20 , Shodai Yoshihiro  115 , Satoshi Yoshimura  116 , Jumpei Yoshimura  8 , Hiroshi Yonekura  117 , Yuki Wakabayashi  118 , Takeshi Wada  119 , Shinichi Watanabe  120 , Atsuhiro Ijiri  111 , Kei Ugata  121 , Shuji Uda  20 , Ryuta Onodera  43 , Masaki Takahashi  119 , Satoshi Nakajima  122 , Junta Honda  46 , Tsuguhiro Matsumoto  20
Affiliations

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024

Nobuaki Shime et al. Acute Med Surg. .

Abstract

The 2024 revised edition of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG 2024) is published by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. This is the fourth revision since the first edition was published in 2012. The purpose of the guidelines is to assist healthcare providers in making appropriate decisions in the treatment of sepsis and septic shock, leading to improved patient outcomes. We aimed to create guidelines that are easy to understand and use for physicians who recognize sepsis and provide initial management, specialized physicians who take over the treatment, and multidisciplinary healthcare providers, including nurses, physical therapists, clinical engineers, and pharmacists. The J-SSCG 2024 covers the following nine areas: diagnosis of sepsis and source control, antimicrobial therapy, initial resuscitation, blood purification, disseminated intravascular coagulation, adjunctive therapy, post-intensive care syndrome, patient and family care, and pediatrics. In these areas, we extracted 78 important clinical issues. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 42 GRADE-based recommendations, 7 good practice statements, and 22 information-to-background questions were created as responses to clinical questions. We also described 12 future research questions.

Keywords: evidence‐based medicine; infection; intensive care; organ failure; systematic review.

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Conflict of interest statement

All committee members and working group members submitted disclosure forms of financial and academic conflict of interest (COI) prior to being requested to participate in individual activities. All COI were collected according to the guideline by the JSICM and the JAAM. Detailed information of COI and the roles in creating this clinical guideline are summarized in Data S4.

Figures

FIGURE 1
FIGURE 1
Summary of recommendations (CQ1 Diagnosis and source control). BQ, background question; CQ, clinical question; FRQ, future research question; GPS, good practice statement; ICU, intensive care unit.
FIGURE 2
FIGURE 2
Summary of recommendations (CQ2 Antimicrobial therapy). BQ, background question; CQ, clinical question; MRSA, methicillin‐resistant Staphylococcus aureus; TDM, therapeutic drug monitoring.
FIGURE 3
FIGURE 3
Summary of recommendations (CQ3 Initial resuscitation). BQ, background question; CQ, clinical question; FRQ, future research question; GPS, good practice statement; Hb, hemoglobin; MAP, mean arterial pressure.
FIGURE 4
FIGURE 4
Summary of recommendations (CQ4 Blood purification). AKI, acute kidney injury; CQ, clinical question; GPS, good practice statement; PMX‐DHP, polymyxin B‐immobilized fiber column; RRT, renal replacement therapy.
FIGURE 5
FIGURE 5
Summary of recommendations (CQ5 Disseminated intravascular coagulation). BQ, background question; CQ, clinical question; DIC; disseminated intravascular coagulation; FRQ, future research question.
FIGURE 6
FIGURE 6
Summary of recommendations (CQ6 Adjuvant therapy). BQ, background question; CQ, clinical question; FRQ, future research question; IVIG, intravenous immunoglobulin; STSS, streptococcal toxic shock syndrome.
FIGURE 7
FIGURE 7
Summary of recommendations (CQ7 Post‐intensive care syndrome). CQ, clinical question; FRQ, future research question; ICU‐AW, intensive care unit‐ acquired weakness; PICS, post‐intensive care syndrome.
FIGURE 8
FIGURE 8
Summary of recommendations (CQ8 Patient and family care). BQ, background question; CQ, clinical question; ICU, intensive care unit.
FIGURE 9
FIGURE 9
Summary of recommendations (CQ9 Pediatrics). BQ, background question; CQ, clinical question; FRQ, future research question; IV, intravenous; IVIG, intravenous immunoglobulin.
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