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

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; GRADE; Infection; Intensive care; Organ failure; Systematic review.

Fig. 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

Fig. 2

Summary of recommendations (CQ2 Antimicrobial therapy). BQ background question, CQ clinical question, MRSA methicillin-resistant Staphylococcus aureus, TDM, therapeutic drug monitoring

Fig. 3

Summary of recommendations (CQ3 Initial resuscitation). BQ background question, CQ clinical question, FRQ future research question, GPS good practice statement, Hb haemoglobin, MAP mean arterial pressure

Fig. 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

Fig. 5

Summary of recommendations (CQ5 Disseminated intravascular coagulation). BQ background question, CQ clinical question, DIC disseminated intravascular coagulation, FRQ future research question

Fig. 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

Fig. 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

Fig. 8

Summary of recommendations (CQ8 Patient and family care). BQ background question, CQ clinical question, ICU intensive care unit

Fig. 9

Summary of recommendations (CQ9 Pediatrics). BQ background question, CQ clinical question, FRQ future research question, IV intravenous, IVIG intravenous immunoglobulin