拯救脓毒症患者行动国际严重脓毒症和脓毒性休克2014 课件.pptxVIP

Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic ShockSlide Presentations Sprung CL, Angus DC, Annane D, Carcillo JA, Deutschman CS, Gerlach H, Jaeschke R, Kleinpell RM, Machado FR, Opal S, Rubenfeld G, Sevransky J, Townsend SR, Dellinger RP. Dellinger RP et al. Crit Care Med. 2013;41:580-637. Dellinger RP et al. Intensive Care Med. 2013;39:165-228. Copyright 2014 SCCM/ESICM SSC 2012 GuidelinesSlide Presentations 1.  Grading of Recommendations: G. Rubenfeld 2.  Initial Resuscitation: D. Annane 3.  Infection-Related Issues: S. Opal 4.  Adjunctive Therapy: H. Gerlach 5.  Mechanical Ventilation: J. Sevransky 6.  Glucose Control, Bicarbonate Therapy: C. Sprung. Slide 2 Copyright 2014 SCCM/ESICM SSC 2012 GuidelinesSlide Presentations 7.  Nutrition: F. Machado, D. Angus 8.  Renal Replacement Therapy: S. Townsend 9.  Prophylaxis for Venous Thromboembolism (VTE): C. Deutschman 10.  Stress Ulcer Prophylaxis (SUP): R. Jaeschke 11.  Setting Goals of Care: R. Kleinpell 12.  Pediatric Considerations: J. Carcillo Slide 3 Copyright 2014 SCCM/ESICM SSC 2012 Guidelines  Grading of Recommendations Assessment, Development , and Evaluation (GRADE) Methodology G. Rubenfeld Slide 4 Copyright 2014 SCCM/ESICM Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Methodology Quality of Evidence Slide 5 Copyright 2014 SCCM/ESICM Downgrading and Upgrading Quality of Evidence RCT Poor quality of planning and implementation Inconsistency of results Indirectness of evidence Imprecision of results High likelihood of reporting bias. Observational Studies Start with a “low quality” rating Magnitude of the effect is very large or large Dose-response relationship All plausible biases would decrease the magnitude of an apparent treatment effect Slide 6 Copyright 2014 SCCM/ESICM Strength of Recommendation Strong Recommend When virtually all informed patients would choose the same management strategy Weak (conditional) Suggest Imply t