解读2008年儿科部脓毒血症与感染性休克管理国际指南.pptVIP

解读2008年脓毒血症与感染性休克管理国际指南（儿科部分） 广州，2009.12.18 广州市妇女儿童医疗中心 广州市儿童医院PICU 杨镒宇 Surviving Sepsis Campaign:International guidelines for managementof severe sepsis and septic shock: 2008 Surviving Sepsis Campaign历史 ? Society of Critical Care Medicine 2007 The article will also be published in Critical Care Medicine. Sponsor of 2004 guidelines; Sponsor of 2008 guidelines but did not participate formally in revision process; Members of the 2007 SSC Guidelines Committee are listed in Appendix I.; Please see Appendix J for author disclosure information. 跨洲、跨国的多中心联合 Sponsoring Organizations: American Association of Critical-Care Nurses*, American College of Chest Physicians*, American College of Emergency Physicians*, Canadian Critical Care Society, European Society of Clinical Microbiology and Infectious Diseases*, European Society of Intensive Care Medicine*, European Respiratory Society*, International Sepsis Forum*, Japanese Association for Acute Medicine, Japanese Society of Intensive Care Medicine, Society of Critical Care Medicine*, Society of Hospital Medicine**, Surgical Infection Society*, World Federation of Societies of Intensive and Critical Care Table 1 Determination of the Quality of Evidence ?Underlying methodology A RCT B Downgraded RCT or upgraded observational studies C Well-done observational studies D Case series or expert opinion ? Factors that may decrease the strength of evidence 1. Poor quality of planning and implementation of available RCTs suggesting high likelihood of bias 2. Inconsistency of results (including problems with subgroup analyses) 3. Indirectness of evidence (differing population, intervention, control, outcomes, comparison) 4. Imprecision of results 5. High likelihood of reporting bias ? Main factors that may increase the strength of evidence 1. Large magnitude of effect (direct evidence, relative risk (RR) 2 with no plausible confounders) 2. Very large magnitude of ef