Abstract
Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.
Highlights
According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [5,6,7], sepsis is defined as a “life-threatening organ dysfunction caused by a dysregulated host response to infection.” The clinical criteria of sepsis are suspected or documented infection and an acute increase in the Sequential Organ Failure Assessment (SOFA) score of 2 points or more
A total of 87 clinical question (CQ) were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-Sepsis Campaign Guidelines (SSCG) 2012)
These guidelines contain some instances in which the recommendations offered differ from those offered for similar clinical questions (CQs) in the SSCG 2016, or that address topics not covered in the SSCG 2016
Summary
According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [5,6,7], sepsis is defined as a “life-threatening organ dysfunction caused by a dysregulated host response to infection.” The clinical criteria of sepsis are suspected or documented infection and an acute increase in the Sequential Organ Failure Assessment (SOFA) score of 2 points or more. Of the various plasma fraction preparations, albumin preparations are discussed alongside “initial resuscitation,” “immunoglobulin preparations” are addressed as a separate entry, and antithrombin preparations are discussed alongside “DIC.” plasma fraction preparations are considered in a similar context as the first edition, it was decided that blood component preparations would be addressed as a separate “blood transfusions” entry, as the guideline would be created based on evidence related to sepsis and the Ministry of Health, Labour and Welfare’s Guidelines for Blood Product Use. Sepsis-induced respiratory system disorders occur at a high frequency and can result in hypoxemia in more severe cases, presenting as acute respiratory distress syndrome (ARDS). The clinical questions (CQs) presented in this chapter were formulated in reference to the aforementioned SSCG 2012 [29] and the consensus statement for the management of pediatric severe sepsis in 2014 [452] (included the American College of Critical Care Medicine/Pediatric Advanced Life Support (ACCM/PALS) algorism [453]), while considering the degree to which they could be supported by the related literature and their importance in the clinical setting. This abridged English edition of the J-SSCG 2016 was produced with permission from the Japanese Association of Acute Medicine and the Japanese Society for Intensive Care Medicine.
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