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Войти в исследования Clinical Criteria for the Definition of Refractory Septic Shock: A Joint Delphi Consensus from the Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM).
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Leone Marc, Myatra Sheila N, Dugar Siddharth, Wieruszewski Patrick M, Russell Lene, Evans Laura, Delamarre Louis, Sharif Sameer, Chew Michelle S, Gong Michelle Ng, Hernández Glenn, Schorr Christa, Lakbar Ines, Smith Susan E, Martin-Loeches Ignacio, Annane Djillali, Balik Martin, Cecconi Maurizio, De Backer Daniel, Donadello Katia, Dünser Martin W, Einav Sharon, Ferrer Ricard, Juffermans Nicole, Hamzaoui Olfa, Landoni Giovanni, Levy Bruno, McKenzie Cathrine, Monnet Xavier, Ostermann Marlies, Spies Claudia, Singer Mervyn, Theodorakopulou Maria, Topeli Arzu, Barreto Erin, Bauer Seth R, Busse Laurence W, Coopersmith Craig M, Deutschman Clifford, Holder Andre L, Kamaleswaran Rishikesan, Legrand Matthieu, Martin Greg S, Maves Ryan C, Nazer Lama, Nunnally Mark E, Prescott Hallie C, Rincon Teresa, Sacha Gretchen L, Seymour Chris W, Arabi Yaseen M, Besen Bruno Amp, Cavalcanti Alexandre Biasi, Deane Adam M, Finfer Simon, Hammond Naomi, Ibarra-Estrada Miguel, Kattan Eduardo, Kotani Yuki, Machado Flavia R, Ospina-Tascón Gustavo A, Mer Mervyn, Young Paul J, Rochwerg Bram, Khanna Ashish K
Аннотация
DESIGN: Review of literature, expert panel position statements, and Delphi rounds with an international expert group.
SETTING: Consensus was defined as having at least 75% of panellists in agreement or disagreement on the three highest or lowest levels of a 7-point Likert scale or based on responses to single- or multiple-choice questions, respectively.
SUBJECTS: A panel of multinational, multiprofessional and multidisciplinary critical care experts assembled by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine (57 invitations and 56 participants).
MEASUREMENTS AND MAIN RESULTS: A five-round Delphi process was conducted for consensus and stability. The steering committee proposed 34 statements, and five of them were rejected by panel experts after round 2. Among 29 statements selected from eight domains, consensus was reached for 13. The panel agreed on the need for a comprehensive consensus set of clinical criteria for refractory septic shock. Markers of organ dysfunction (75%, 2 rounds), tissue perfusion (91.1%, 2 rounds) including lactate (94.6%, 2 rounds) and capillary refill time (76.8%, 2 rounds), assessment of fluid-responsiveness after initial resuscitation (92.9%, 5 rounds), and use of vasoactive drugs at norepinephrine equivalents greater than 0.5 µg/kg/min (75.0%, 3 rounds), were selected as clinical criteria of refractory septic shock. The use of critical care ultrasound (CCUS) (92.9%, 3 rounds) was the single diagnostic modality that reached a consensus-based agreement.
CONCLUSIONS: A consensus for 13 criteria to frame the definition of refractory septic shock was reached. Refractory septic shock is characterised by persistently elevated lactate concentrations and or prolonged capillary refill time in patients with septic shock who are fluid unresponsive, require a norepinephrine base equivalent dose greater than 0.5 micrograms per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.