Management of adult sepsis in resource-limited settings: global expert consensus statements using a Delphi method
Issued Date
2024-01-01
Resource Type
ISSN
03424642
eISSN
14321238
Scopus ID
2-s2.0-85212821891
Journal Title
Intensive Care Medicine
Rights Holder(s)
SCOPUS
Bibliographic Citation
Intensive Care Medicine (2024)
Suggested Citation
Thwaites L., Nasa P., Abbenbroek B., Dat V.Q., Finfer S., Kwizera A., Ling L., Lobo S.M., Sinto R., Aditianingsih D., Antonelli M., Arabi Y.M., Argent A., Azevedo L., Bennett E., Chakrabarti A., De Asis K., De Waele J., Divatia J.V., Estenssoro E., Evans L., Faiz A., Hammond N.E., Hashmi M., Herridge M.S., Jacob S.T., Jatsho J., Javeri Y., Khalid K., Chen L.K., Levy M., Lundeg G., Machado F.R., Mehta Y., Mer M., Son D.N., Ospina-Tascón G.A., Ostermann M., Permpikul C., Prescott H.C., Reinhart K., Rodriguez Vega G., S-Kabara H., Shrestha G.S., Waweru-Siika W., Tan T.L., Todi S., Tripathy S., Venkatesh B., Vincent J.L., Myatra S.N. Management of adult sepsis in resource-limited settings: global expert consensus statements using a Delphi method. Intensive Care Medicine (2024). doi:10.1007/s00134-024-07735-7 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/102560
Title
Management of adult sepsis in resource-limited settings: global expert consensus statements using a Delphi method
Author(s)
Thwaites L.
Nasa P.
Abbenbroek B.
Dat V.Q.
Finfer S.
Kwizera A.
Ling L.
Lobo S.M.
Sinto R.
Aditianingsih D.
Antonelli M.
Arabi Y.M.
Argent A.
Azevedo L.
Bennett E.
Chakrabarti A.
De Asis K.
De Waele J.
Divatia J.V.
Estenssoro E.
Evans L.
Faiz A.
Hammond N.E.
Hashmi M.
Herridge M.S.
Jacob S.T.
Jatsho J.
Javeri Y.
Khalid K.
Chen L.K.
Levy M.
Lundeg G.
Machado F.R.
Mehta Y.
Mer M.
Son D.N.
Ospina-Tascón G.A.
Ostermann M.
Permpikul C.
Prescott H.C.
Reinhart K.
Rodriguez Vega G.
S-Kabara H.
Shrestha G.S.
Waweru-Siika W.
Tan T.L.
Todi S.
Tripathy S.
Venkatesh B.
Vincent J.L.
Myatra S.N.
Nasa P.
Abbenbroek B.
Dat V.Q.
Finfer S.
Kwizera A.
Ling L.
Lobo S.M.
Sinto R.
Aditianingsih D.
Antonelli M.
Arabi Y.M.
Argent A.
Azevedo L.
Bennett E.
Chakrabarti A.
De Asis K.
De Waele J.
Divatia J.V.
Estenssoro E.
Evans L.
Faiz A.
Hammond N.E.
Hashmi M.
Herridge M.S.
Jacob S.T.
Jatsho J.
Javeri Y.
Khalid K.
Chen L.K.
Levy M.
Lundeg G.
Machado F.R.
Mehta Y.
Mer M.
Son D.N.
Ospina-Tascón G.A.
Ostermann M.
Permpikul C.
Prescott H.C.
Reinhart K.
Rodriguez Vega G.
S-Kabara H.
Shrestha G.S.
Waweru-Siika W.
Tan T.L.
Todi S.
Tripathy S.
Venkatesh B.
Vincent J.L.
Myatra S.N.
Author's Affiliation
Manipal Health Enterprises Pvt Ltd
The Aga Khan University Kenya
VNU-University of Medicine and Pharmacy
Siriraj Hospital
Makerere University College of Health Sciences
Oxford University Clinical Research Unit
Fiji National University
All India Institute of Medical Sciences, Bhubaneswar
Fundación Valle del Lili
Medanta - The Medicity
Ministerio de Salud de la provincia de Buenos Aires
Muhimbili University of Health and Allied Sciences
Ziauddin University
University of the Witwatersrand Faculty of Health Sciences
King Saud bin Abdulaziz University for Health Sciences
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Mongolian National University of Medical Sciences
Colonial War Memorial Hospital Fiji
Tribhuvan University Teaching Hospital
Hanoi Medical University
NMC Specialty Hospital
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Universitair Ziekenhuis Gent
Hôpital Erasme
Hospital de Base
University of Washington School of Medicine
UNSW Sydney
Charité – Universitätsmedizin Berlin
University of Michigan, Ann Arbor
Liverpool School of Tropical Medicine
New Cross Hospital
Imperial College Faculty of Medicine
Toronto General Hospital Research Institute
Monash University
Tata Memorial Hospital
Hospital Israelita Albert Einstein
Universidade Federal de São Paulo
The Warren Alpert Medical School
Royal North Shore Hospital
Charlotte Maxeke Johannesburg Academic Hospital
Guy's and St Thomas' NHS Foundation Trust
Bayero University
Chinese University of Hong Kong
Faculty of Medicine, UKM
University of Cape Town
Asia Pacific Sepsis Alliance
Gyaltsuen Jetsun Pema Wangchuck Mother and Child Hospital
Global Sepsis Alliance & Sepsis-Stiftung Berlin
Doodhadhari Burfani Hospital and Research Institute
HIMA-San Pablo Caguas
Regency Super Speciality Hospital
St. Luke's Medical Centre
Asiatic Society of Bangladesh
The Aga Khan University Kenya
VNU-University of Medicine and Pharmacy
Siriraj Hospital
Makerere University College of Health Sciences
Oxford University Clinical Research Unit
Fiji National University
All India Institute of Medical Sciences, Bhubaneswar
Fundación Valle del Lili
Medanta - The Medicity
Ministerio de Salud de la provincia de Buenos Aires
Muhimbili University of Health and Allied Sciences
Ziauddin University
University of the Witwatersrand Faculty of Health Sciences
King Saud bin Abdulaziz University for Health Sciences
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Mongolian National University of Medical Sciences
Colonial War Memorial Hospital Fiji
Tribhuvan University Teaching Hospital
Hanoi Medical University
NMC Specialty Hospital
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Universitair Ziekenhuis Gent
Hôpital Erasme
Hospital de Base
University of Washington School of Medicine
UNSW Sydney
Charité – Universitätsmedizin Berlin
University of Michigan, Ann Arbor
Liverpool School of Tropical Medicine
New Cross Hospital
Imperial College Faculty of Medicine
Toronto General Hospital Research Institute
Monash University
Tata Memorial Hospital
Hospital Israelita Albert Einstein
Universidade Federal de São Paulo
The Warren Alpert Medical School
Royal North Shore Hospital
Charlotte Maxeke Johannesburg Academic Hospital
Guy's and St Thomas' NHS Foundation Trust
Bayero University
Chinese University of Hong Kong
Faculty of Medicine, UKM
University of Cape Town
Asia Pacific Sepsis Alliance
Gyaltsuen Jetsun Pema Wangchuck Mother and Child Hospital
Global Sepsis Alliance & Sepsis-Stiftung Berlin
Doodhadhari Burfani Hospital and Research Institute
HIMA-San Pablo Caguas
Regency Super Speciality Hospital
St. Luke's Medical Centre
Asiatic Society of Bangladesh
Corresponding Author(s)
Other Contributor(s)
Abstract
Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings. Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the final consensus statements. Results: A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include consensus on managing patients with sepsis outside a designated critical care area, triggers for escalating clinical management and criteria for safe transfer to another facility. The experts agreed on the following: in the absence of serum lactate, clinical parameters such as altered mental status, capillary refill time and urine output may be used to guide resuscitation; special considerations regarding the volume of fluid used for resuscitation, especially in tropical infections, including the use of simple tests to assess fluid responsiveness when facilities for advanced hemodynamic monitoring are limited; use of Ringer’s lactate or Hartmann’s solution as balanced salt solutions; epinephrine when norepinephrine or vasopressin are unavailable; and the administration of vasopressors via a peripheral vein if central venous access is unavailable or not feasible. Similarly, where facilities for investigation are unavailable, there was consensus for empirical antimicrobial administration without delay when sepsis was strongly suspected, as was the empirical use of antiparasitic agents in patients with suspicion of parasitic infections. Conclusion: Using a Delphi method, international experts reached consensus to generate expert clinical practice statements providing guidance to clinicians worldwide on the management of sepsis in resource-limited settings. These statements complement existing guidelines where evidence is lacking and add relevant aspects of sepsis management that are not addressed by current international guidelines. Future studies are needed to assess the effects of these practice statements and address remaining uncertainties.