Surviving Sepsis Campaign Background
The work to improving sepsis patients' outcomes began in 2003 with the convening of infectious diseases and critical care experts from across the world, representing 11 international organizations. Culling through and rating the evidence available, this group developed guidelines (published in 2004) for bedside care of severe sepsis and septic shock and updated these guidelines in 2008 and 2012. The stated objectives were to increase awareness and diagnosis of septic patients followed by implementing EBP changes and reduce sepsis related mortality. Measuring the impact of changed practice was requisite and an international data base was developed and implemented.
The Surviving Sepsis Campaign is in partnership with the Society of Critical Care Medicine, European Society of Intensive Care Medicine, and International Sepsis Forum. These groups teamed up with the Institute of Health Care Improvement to promote the campaign. It has been endorsed by numerous nursing organizations including the American Association of Critical Care. Additional supporting organizations include the following: American Association of Critical-Care Nurses; American College of Chest Physicians; American College of Emergency Physicians; American Thoracic Society; Australian and New Zealand Intensive Care Society; European Society of Clinical Microbiology and Infectious Diseases; European Society of Intensive Care Medicine; European Respiratory Society; International Sepsis Forum; Society of Critical Care Medicine; and the Surgical Infection Society among others.
The Purpose of the Surviving Sepsis Campaign
To "Reduce the mortality associated with sepsis by 25% over the next five years."
Steps to Take
- The first step is early and rapid identification of severe sepsis and septic shock.
- Once identified, rapid implementation of EBP resuscitation elements within 1-6 hours.
- Lastly, implement evidenced based practices that continue to support the patient after the initial EBP resuscitation phase.
Reviewing the Evidence
The experts reviewed existing evidence to determine the specific items to be included. Their intent was to include as recommendations only those interventions that demonstrated improved outcomes in severe sepsis and septic shock, specifically identified as reduction in mortality.
The expert panel grouped the recommendations into early goal directed therapy or resuscitation interventions. Available evidence supporting the recommendation was graded as 1, strong and 2, weak; quality of supporting data was designated as A, very high to D very low. In order to be included as a recommendation, at least 80% of the expert panel participants had to agree that the item should be included as a recommendation. The strength was identified as 1 or strongly supported if at least 70% of the group indicated a strong support for the item. The element was assigned a 2 or weak support if less than 70% of the experts strongly supported the item. Factors that resulted in upgrading or downgrading of specific evidence are included for your review.
Underlying Methodology
- Random controlled trial (RCT)
- Downgraded RCT or upgraded observational studies
- Well-done observational studies
- Case series or expert opinion
Factors that May Decrease the Strength of Evidence
- Poor quality of planning and implementation of available RCT suggesting high likelihood of bias
- Inconsistency of results (including problems with subgroup analysis)
- Indirectness of evidence (differing population, intervention, control, outcomes, comparison)
- Imprecision of results
- High likelihood of reporting bias
Main factors that May Increase the Strength of Evidence
- Large magnitude of effect (direct evidence, relative risk (RR) >2 with no plausible confounders)
- Very large magnitude of effect with RR>5 and no threats to validity (by two levels)
- Dose response gradient
Method Used by the Expert Team to Grade
The method used by the expert team to grade the level of the evidence is outlined above. While it is ideal to have an abundance of well-designed, randomized controlled trials (RCT), this clearly is not always available. At times, the best evidence available may be expert opinion or review of clinical cases. Additionally, some RCT, while they have merit, are not optimally designed or conducted. Thus, while the findings are important, they do not lend the same power of assurance as do other more well-designed studies. Taking this into account, the group rated the quality of supporting data for recommendations from A to C, with A representative of the most well studied based on available data and D with the least available research support.
