Surviving sepsis campaign: research priorities for sepsis and septic shock

Craig M Coopersmith, Daniel De Backer, Clifford S Deutschman, Ricard Ferrer, Ishaq Lat, Flavia R Machado, Greg S Martin, Ignacio Martin-Loeches, Mark E Nunnally, Massimo Antonelli, Laura E Evans, Judith Hellman, Sameer Jog, Jozef Kesecioglu, Mitchell M Levy, Andrew Rhodes, Craig M Coopersmith, Daniel De Backer, Clifford S Deutschman, Ricard Ferrer, Ishaq Lat, Flavia R Machado, Greg S Martin, Ignacio Martin-Loeches, Mark E Nunnally, Massimo Antonelli, Laura E Evans, Judith Hellman, Sameer Jog, Jozef Kesecioglu, Mitchell M Levy, Andrew Rhodes

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 (ESM 1 - supplemental table 1) 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.

Keywords: Priorities; Research; Sepsis; Septic shock; Surviving Sepsis Campaign.

Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
Flowchart identifying process of narrowing to top research questions

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