The Frame of Survival for Sepsis: A Practical Systems Framework for Time-Sensitive Critical Illness in Low-Resource Settings
Issued Date
2026-01-01
Resource Type
ISSN
00903493
eISSN
15300293
Scopus ID
2-s2.0-105035748628
Pubmed ID
41860329
Journal Title
Critical Care Medicine
Rights Holder(s)
SCOPUS
Bibliographic Citation
Critical Care Medicine (2026)
Suggested Citation
Hidalgo J.L., Akech S.O., Acharya S.P., Coopersmith C.M., Jacob S.T., Johnston C., Kissoon N., Machado F.R., Maves R.C., Molyneux E., Morrow B.M., Myatra S.N., Pérez Cornejo M.S., Perez-Fernandez J., Permpikul C., Piyavechviratana K., Rhodes A., Kortz T.B., Kumar V.K., Ulisubisya M.M., Nadkarni V. The Frame of Survival for Sepsis: A Practical Systems Framework for Time-Sensitive Critical Illness in Low-Resource Settings. Critical Care Medicine (2026). doi:10.1097/CCM.0000000000007093 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116313
Title
The Frame of Survival for Sepsis: A Practical Systems Framework for Time-Sensitive Critical Illness in Low-Resource Settings
Author's Affiliation
Universidade de São Paulo
The University of British Columbia
University of California, San Francisco
UCSF School of Medicine
University of Pennsylvania Perelman School of Medicine
University of Cape Town
Universidade Federal de São Paulo
Wake Forest University School of Medicine
Siriraj Hospital
Liverpool School of Tropical Medicine
Tata Memorial Hospital
St George's University Hospitals NHS Foundation Trust
Kamuzu University of Health Sciences
Herbert Wertheim College of Medicine
Emory Healthcare
Wellcome Trust Research Laboratories Nairobi
Phramongkutklao College of Medicine
Tribhuvan University Teaching Hospital
Society of Critical Care Medicine
Muhimbili Orthopaedic Institute
Walimu
Belize Healthcare Partners
State General Hospital
The University of British Columbia
University of California, San Francisco
UCSF School of Medicine
University of Pennsylvania Perelman School of Medicine
University of Cape Town
Universidade Federal de São Paulo
Wake Forest University School of Medicine
Siriraj Hospital
Liverpool School of Tropical Medicine
Tata Memorial Hospital
St George's University Hospitals NHS Foundation Trust
Kamuzu University of Health Sciences
Herbert Wertheim College of Medicine
Emory Healthcare
Wellcome Trust Research Laboratories Nairobi
Phramongkutklao College of Medicine
Tribhuvan University Teaching Hospital
Society of Critical Care Medicine
Muhimbili Orthopaedic Institute
Walimu
Belize Healthcare Partners
State General Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives: – Sepsis is a time-sensitive cause of preventable death worldwide, with disproportionate mortality in low-resource settings (LRS). Many recommendations in international sepsis guidance presume resources unavailable in many facilities and communities. We sought to develop a practical framework that helps health systems embed feasible sepsis actions within broader emergency and essential critical care systems, while highlighting where evidence is limited and where local learning systems are needed. Data Sources: – A targeted scoping review of peer-reviewed and grey literature on sepsis epidemiology, emergency care systems, essential emergency and critical care, implementation strategies, and quality improvement (QI) in LRS; and key guideline and policy documents relevant to sepsis and emergency care. Study Selection: – We prioritized publications and guidance relevant to LRS, including observational studies, pragmatic implementation reports, consensus statements, and policies addressing emergency care organization, workforce, supply chains, diagnostics, and QI. Data Extraction: – Task force members abstracted actionable strategies, implementation barriers/enablers, and feasibility considerations across the care continuum (community, transport/prehospital, facility-based acute care, and referral). We also identified domains where guideline certainty is low or indirect for LRS. Data Synthesis: – A Society of Critical Care Medicine-convened multidisciplinary task force iteratively developed the “Sepsis Frame of Survival” using a structured process that included 1) scoping evidence review, 2) a Delphi-style prioritization of candidate framework elements by importance and feasibility, and 3) a structured consensus meeting (“Utstein-style” conference format) to finalize the model and its priority actions. We produced a concise implementation roadmap and a feasible measurement set aligned with resource constraints. Conclusions: – The Sepsis Frame of Survival is a pragmatic model to organize sepsis improvement as part of emergency and essential critical care strengthening. It emphasizes high-impact actions that can be implemented with limited resources (triage and early recognition, timely antimicrobials, oxygen and basic supportive care, cautious fluid resuscitation with reassessment, source control and referral, diagnostics/microbiology where feasible, and QI). The framework explicitly distinguishes near-term, feasible changes from longer-term system investments and highlights the need for locally generated evidence to guide quality indicators and resuscitation strategies in LRS.