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The impact of the severe acute respiratory syndrome coronavirus 2 pandemic is placing tremendous pressure on government and the biomedical research enterprise to quickly develop safe, effective therapies and move [...]

Summary Nurses often have an important role in devising or updating local policies and protocols, but are rarely prepared for a process that requires careful consideration of existing resources and [...]

When damage from a hurricane led to the closure of Vermont's only state-run psychiatric facility, the situation ultimately presented an unforeseen opportunity. In time, the facility transformed from 'the scapegoat [...]

Byline: R. Phillip Dellinger (1,15), Jean M. Carlet (2), Henry Masur (3), Herwig Gerlach (4), Thierry Calandra (5), Jonathan Cohen (6), Juan Gea-Banacloche (8), Didier Keh (7), John C. Marshall (9), Margaret M. Parker (10), Graham Ramsay (11), Janice L. Zimmerman (12), Jean-Louis Vincent (13), M. M. Levy (14) Keywords: Sepsis; Severe sepsis; Septic shock; Sepsis syndrome; Infection; Guidelines; Evidence-based medicine; Surviving Sepsis Campaign Abstract: Objective To develop management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. Design The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations built upon a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along 5 levels to create recommendation grades from A--E, with A being the highest grade. Pediatric considerations were provided to contrast adult and pediatric management. Participants Participants included 44 critical care and infectious disease experts representing 11 international organizations. Results A total of 46 recommendations plus pediatric management considerations. Conclusions Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient. The impact of these guidelines will be formally tested and guidelines updated annually, and even more rapidly when some important new knowledge becomes available. Author Affiliation: (1) Section of Critical Care Medicine, Cooper University Hospital, One Cooper Plaza, 393 Dorrance, Camden, NJ 08103, USA (2) Service de la Reanimation Polyvalente, Fondation Hopital Saint-Joseph, Paris, France (3) Critical Care Medicine, National Institutes of Health, Bethesda, MD, USA (4) Dept. for Anesthesiology & Critical Care Medicine, Vivantes-Klinikum Neukoelln, Berlin, Germany (5) Laboratoire de Maladies Infectieuses Dept. de Medecine Interne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (6) Brighton and Sussex Medical School, Falmer, United Kingdom (7) Clinic of Anesthesiology and Surgical Intensive Care Medicine, Charite, Campus Virchow-Clinic, Berlin, Germany (8) Infectious Disease Section, Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA (9) Toronto General Hospital, Toronto, Ontario, Canada (10) Pediatrics, SUNY at Stony Brook, Stony Brook, NY, USA (11) University Hospital, Mastricht, Netherlands (12) Department of Medicine, Baylor College of Medicine, Houston, TX, USA (13) Department of Intensive Care, Erasme University Hospital, Brussels, Belgium (14) Brown University School of Medicine, Providence, RI, USA (15) Cooper Health Systems, One Cooper Plaza, 393 Dorrance, Camden, NJ 08103, USA Article History: Registration Date: 02/02/2004 Received Date: 06/01/2004 Accepted Date: 29/01/2004 Online Date: 03/03/2004 Article note: This article is published jointly with Critical Care Medicine Electronic Supplementary Material Supplementary material is available in the online version of this articel at http://dx.doi.org/10.1007/s00134-004-2210-z Chairs: R. Phillip Dellinger, MD* Henry Masur, MD Jean M. Carlet, MD Herwig Gerlach, MD, PhD**. Committee members: Richard J. Beale, MD** Marc Bonten, MD Christian Brun-Buisson, MD Thierry Calandra, MD Joseph A. Carcillo, MD Jonathan Cohen, MD** Catherine Cordonnier, MD E. Patchen Dellinger, MD Jean-Francois Dhainaut, MD, PhD Roger G. Finch, MD Simon Finfer, MD Francois A. Fourrier, MD Juan Gea-Banacloche MD Maurene A. Harvey, RN, MPH** Jan A. Hazelzet, MD Steven M. Hollenberg, MD James H. Jorgensen, PhD Didier Keh, MD Mitchell M. Levy*, MD Ronald V. Maier, MD Dennis G. Maki, MD John J. Marini, MD John C. Marshall, MD Steven M. Opal, MD Tiffany M. Osborn, MD Margaret M. Parker, MD** Joseph E. Parrillo, MD Graham Ramsay, MD* Andrew Rhodes, MD Jonathan E. Sevransky, MD Charles L. Sprung, MD, JD** Antoni Torres, MD Jeffery S. Vender, MD Jean-Louis Vincent, MD, PhD** Janice L. Zimmerman, MD. Associate members: E. David Bennett, MD Pierre-Yves Bochud, MD Alain Cariou, MD Glenn S. Murphy, MD Martin Nitsun, MD Joseph W. Szokol, MD Stephen Trzeciak, MD Christophe Vinsonneau, MD. *Executive Committee, Surviving Sepsis Campaign. **Steering Committee, Surviving Sepsis Campaign. Sponsoring organizations: 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 Surgical Infection Society. The Surviving Sepsis Campaign is administered jointly by the European Society of Intensive Care Medicine, International Sepsis Forum, and the Society of Critical Care Medicine, and is supported in part by unrestricted educational grants from Baxter Bioscience, Edwards Lifesciences, and Eli Lilly and Company (majority sponsor). The authors and the publisher have exercised great care to ensure that drug dosages, formulas, and other information presented in this book are accurate and in accord with the professional standards in effect at the time of publication. Readers are, however, advised to always check the manufacturer's product information sheet that is packaged with the respective products to be fully informed of changes in recommended dosages, contraindications, and the like before prescribing or administering any drug.

Author(s): Andrew Rhodes [sup.1] , Rui P. Moreno [sup.2] , Jean-Daniel Chiche [sup.3] [sup.4] [sup.5] [sup.6] [sup.7] Author Affiliations: (1) grid.451349.e, Department of Intensive Care Medicine, St George's Healthcare NHS [...]

SUMMARY A health board in Scotland has introduced a policy to protect staff who are subjected to stalking. Keywords Stalking and harassment * Health and safety at work * Policies [...]

The National Institute for Health and Clinical Excellence (NICE) makes some of the most difficult decisions in public life, so understandably it attracts attention from the media, health professionals and [...]

All clinicians are aware of NICE guidance, but did you know that they also provide support for putting guidelines into practice? This website has expanded and now provides implementation tools, [...]

As members of Theatre Team 2 working at Camp Bastion military hospital, Afghanistan, theatre sister lieutenant colonel Carine Horsburgh (pictured) and orthopaedic theatre team leader captain Margot McCrone were in [...]

Fresh guidance on record-keeping is being developed by the Nursing and Midwifery Council to help nurses who struggle to keep good documentation. The project will focus on developing critical thinking [...]

NHS staff battled through heavy snowfall and sub-zero temperatures to minimise disruption to health services last week. Midwife Joann Newby from Bridlington and District General Hospital, North Humberside, carried out [...]

The RCN is seeking practitioners experienced in end of life care to help develop guidance on assisted suicide. The nurse experts will be part of the RCN's assisted suicide guidance [...]

National standards are needed to ensure all nurses who care for patients with dementia have had training in the condition, a leading nurse expert said last week. Dementia Services Development [...]

The British Geriatrics Society has launched a website providing comprehensive information on the specialist care of older people. It includes best practice guides, clinical guidelines and reference materials that cover [...]

THE GOVERNMENT has released best practice guidance on its plans to implement evidence-based talking therapies throughout England by 2012. The Improving Access to Psychological Therapies (IAPT) programme is designed to [...]

The Scottish Intercollegiate Guideline Network (Sign) is updating several of its guidelines. Development groups will review the most recent evidence and make necessary changes. Professionals interested in critically appraising scientific [...]

Guidance for healthcare professionals on the care and treatment of children who wet the bed is being developed by the National Institute for Health and Clinical Excellence. Draft recommendations cover [...]

What do I do now? * Using the information in section 1 below to guide you, write a practice profile of between 750 and 1,000 words--ensuring that you have related [...]

A SIX-PAGE leaflet for nurses on how to deal with stroke patients was released this week. The Nursing Concise Guide for Stroke provides an overview of recommendations already in the [...]

HEALTH CARE for critically ill people has improved enormously over the past few years largely due to better dissemination and application of best practice knowledge. Guidelines about expanded nursing roles [...]