Special Articles

Surviving Sepsis Campaign: Research Priorities for Sepsis and Septic Shock

Coopersmith, Craig M. MD, FCCM (Co-chair)¹; De Backer, Daniel MD, PhD (Co-chair)²; Deutschman, Clifford S. MS, MD, MCCM³; Ferrer, Ricard MD, PhD⁴; Lat, Ishaq PharmD⁵; Machado, Flavia R. MD, PhD⁶; Martin, Greg S. MD, MSc, FCCM⁷; Martin-Loeches, Ignacio MD⁸; Nunnally, Mark E. MD, FCCM⁹; Antonelli, Massimo MD¹⁰; Evans, Laura E. MD, MSc, FCCM¹¹; Hellman, Judith MD¹²; Jog, Sameer MD, IDCCM¹³; Kesecioglu, Jozef MD, PhD¹⁴; Levy, Mitchell M. MD, MCCM¹⁵; Rhodes, Andrew MB BS, MD (Res)¹⁶

Author Information

¹Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA.

²Chirec Hospitals, Université Libre de Bruxelles, Brussels, Belgium.

³Department of Pediatrics, Cohen Children’s Medical center, Northwell Health, New Hyde Park, NY and the Feinstein Institute for Medical Research/Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA.

⁴Intensive Care Department, Vall d’Hebron University Hospital; Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d’Hebron Institut de Recerca, Barcelona, Spain.

⁵Rush University Medical Center, Chicago, IL, USA.

⁶Universidade Federal de São Paulo, Sao Paulo, Brazil.

⁷Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Grady Memorial Hospital and Emory Critical Care Center, Emory University, Atlanta, GA, USA.

⁸Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St. James’s University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.

⁹New York University School of Medicine, New York, NY, USA.

¹⁰Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A.Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy.

¹¹Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Bellevue Hospital Center and New York University School of Medicine, New York, NY, USA.

¹²University of California, San Francisco, San Francisco, California, USA.

¹³Consultant Intensivist, Deenanath Mangeshkar Hospital and Research center, Pune, India.

¹⁴Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands.

¹⁵Alpert Medical School at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.

¹⁶Department of Adult Critical Care, St. George’s University Hospitals NHS Foundation Trust and St George’s University of London, London, UK.

This article is being simultaneously published in Critical Care Medicine and Intensive Care Medicine in the August issue of both journals.

Craig M. Coopersmith and Daniel De Backer are co-chairs of the committee who contributed equally to the final manuscript.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Surviving Sepsis Research Subgroup Heads: Clifford Deutschman (basic/translational science), Ricard Ferrer (administration/epidemiology), Ishaq Lat (fluids and vasoactive agents), Flavia R. Machado (post-intensive care unit), Greg S. Martin (adjunctive therapy), Ignacio Martin-Loeches (infection), Mark E. Nunnally (scoring/identification)

Conflicts of Interest: 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.

For information regarding this article, Email: [email protected]

Critical Care Medicine 46(8):p 1334-1356, August 2018. | DOI: 10.1097/CCM.0000000000003225

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 (Supplemental Table 1, Supplemental Digital Content 2, https://links.lww.com/CCM/D636) 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.