The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016)

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Abstract

Background and purpose

The 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 and published in the Journal of JSICM, [2017; Volume 24 (supplement 2)] 10.3918/jsicm.24S0001 and Journal of Japanese Association for Acute Medicine [2017; Volume 28, (supplement 1)] http://onlinelibrary.wiley.com/doi/10.1002/jja2.2017.28.issue-S1/issuetoc.

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.

Methods

Members 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.

Results

A 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 five CQs.

Conclusions

Based 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.

Electronic supplementary material

The online version of this article (10.1186/s40560-017-0270-8) contains supplementary material, which is available to authorized users.

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Most cited references 346

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Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.

M. B. P. Amato, C Barbas, D M Medeiros … (1998)

In patients with the acute respiratory distress syndrome, massive alveolar collapse and cyclic lung reopening and overdistention during mechanical ventilation may perpetuate alveolar injury. We determined whether a ventilatory strategy designed to minimize such lung injuries could reduce not only pulmonary complications but also mortality at 28 days in patients with the acute respiratory distress syndrome. We randomly assigned 53 patients with early acute respiratory distress syndrome (including 28 described previously), all of whom were receiving identical hemodynamic and general support, to conventional or protective mechanical ventilation. Conventional ventilation was based on the strategy of maintaining the lowest positive end-expiratory pressure (PEEP) for acceptable oxygenation, with a tidal volume of 12 ml per kilogram of body weight and normal arterial carbon dioxide levels (35 to 38 mm Hg). Protective ventilation involved end-expiratory pressures above the lower inflection point on the static pressure-volume curve, a tidal volume of less than 6 ml per kilogram, driving pressures of less than 20 cm of water above the PEEP value, permissive hypercapnia, and preferential use of pressure-limited ventilatory modes. After 28 days, 11 of 29 patients (38 percent) in the protective-ventilation group had died, as compared with 17 of 24 (71 percent) in the conventional-ventilation group (P<0.001). The rates of weaning from mechanical ventilation were 66 percent in the protective-ventilation group and 29 percent in the conventional-ventilation group (P=0.005): the rates of clinical barotrauma were 7 percent and 42 percent, respectively (P=0.02), despite the use of higher PEEP and mean airway pressures in the protective-ventilation group. The difference in survival to hospital discharge was not significant; 13 of 29 patients (45 percent) in the protective-ventilation group died in the hospital, as compared with 17 of 24 in the conventional-ventilation group (71 percent, P=0.37). As compared with conventional ventilation, the protective strategy was associated with improved survival at 28 days, a higher rate of weaning from mechanical ventilation, and a lower rate of barotrauma in patients with the acute respiratory distress syndrome. Protective ventilation was not associated with a higher rate of survival to hospital discharge.

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Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial.

Timothy Girard, John Kress, Barry Fuchs … (2008)

Approaches to removal of sedation and mechanical ventilation for critically ill patients vary widely. Our aim was to assess a protocol that paired spontaneous awakening trials (SATs)-ie, daily interruption of sedatives-with spontaneous breathing trials (SBTs). In four tertiary-care hospitals, we randomly assigned 336 mechanically ventilated patients in intensive care to management with a daily SAT followed by an SBT (intervention group; n=168) or with sedation per usual care plus a daily SBT (control group; n=168). The primary endpoint was time breathing without assistance. Data were analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00097630. One patient in the intervention group did not begin their assigned treatment protocol because of withdrawal of consent and thus was excluded from analyses and lost to follow-up. Seven patients in the control group discontinued their assigned protocol, and two of these patients were lost to follow-up. Patients in the intervention group spent more days breathing without assistance during the 28-day study period than did those in the control group (14.7 days vs 11.6 days; mean difference 3.1 days, 95% CI 0.7 to 5.6; p=0.02) and were discharged from intensive care (median time in intensive care 9.1 days vs 12.9 days; p=0.01) and the hospital earlier (median time in the hospital 14.9 days vs 19.2 days; p=0.04). More patients in the intervention group self-extubated than in the control group (16 patients vs six patients; 6.0% difference, 95% CI 0.6% to 11.8%; p=0.03), but the number of patients who required reintubation after self-extubation was similar (five patients vs three patients; 1.2% difference, 95% CI -5.2% to 2.5%; p=0.47), as were total reintubation rates (13.8%vs 12.5%; 1.3% difference, 95% CI -8.6% to 6.1%; p=0.73). At any instant during the year after enrolment, patients in the intervention group were less likely to die than were patients in the control group (HR 0.68, 95% CI 0.50 to 0.92; p=0.01). For every seven patients treated with the intervention, one life was saved (number needed to treat was 7.4, 95% CI 4.2 to 35.5). Our results suggest that a wake up and breathe protocol that pairs daily spontaneous awakening trials (ie, interruption of sedatives) with daily spontaneous breathing trials results in better outcomes for mechanically ventilated patients in intensive care than current standard approaches and should become routine practice.

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Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.

Alain Mercat, Jean-Christophe Richard, Bruno Vielle … (2008)

The need for lung protection is universally accepted, but the optimal level of positive end-expiratory pressure (PEEP) in patients with acute lung injury (ALI) or acute respiratory distress syndrome remains debated. To compare the effect on outcome of a strategy for setting PEEP aimed at increasing alveolar recruitment while limiting hyperinflation to one aimed at minimizing alveolar distension in patients with ALI. A multicenter randomized controlled trial of 767 adults (mean [SD] age, 59.9 [15.4] years) with ALI conducted in 37 intensive care units in France from September 2002 to December 2005. Tidal volume was set at 6 mL/kg of predicted body weight in both strategies. Patients were randomly assigned to a moderate PEEP strategy (5-9 cm H(2)O) (minimal distension strategy; n = 382) or to a level of PEEP set to reach a plateau pressure of 28 to 30 cm H(2)O (increased recruitment strategy; n = 385). The primary end point was mortality at 28 days. Secondary end points were hospital mortality at 60 days, ventilator-free days, and organ failure-free days at 28 days. The 28-day mortality rate in the minimal distension group was 31.2% (n = 119) vs 27.8% (n = 107) in the increased recruitment group (relative risk, 1.12 [95% confidence interval, 0.90-1.40]; P = .31). The hospital mortality rate in the minimal distension group was 39.0% (n = 149) vs 35.4% (n = 136) in the increased recruitment group (relative risk, 1.10 [95% confidence interval, 0.92-1.32]; P = .30). The increased recruitment group compared with the minimal distension group had a higher median number of ventilator-free days (7 [interquartile range {IQR}, 0-19] vs 3 [IQR, 0-17]; P = .04) and organ failure-free days (6 [IQR, 0-18] vs 2 [IQR, 0-16]; P = .04). This strategy also was associated with higher compliance values, better oxygenation, less use of adjunctive therapies, and larger fluid requirements. A strategy for setting PEEP aimed at increasing alveolar recruitment while limiting hyperinflation did not significantly reduce mortality. However, it did improve lung function and reduced the duration of mechanical ventilation and the duration of organ failure. clinicaltrials.gov Identifier: NCT00188058.

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Author and article information

Contributors

Osamu Nishida: 0562-93-9008 , nishida@fujita-hu.ac.jp

Journal

Journal ID (nlm-ta): J Intensive Care

Journal ID (iso-abbrev): J Intensive Care

Title: Journal of Intensive Care

Publisher: BioMed Central (London )

ISSN (Electronic): 2052-0492

Publication date (Electronic): 2 February 2018

Publication date PMC-release: 2 February 2018

Publication date Collection: 2018

Volume: 6

Electronic Location Identifier: 7

Affiliations

[1 ]ISNI 0000 0004 1761 798X, GRID grid.256115.4, Department of Anesthesiology and Critical Care Medicine, , Fujita Health University School of Medicine, ; 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan

[2 ]ISNI 0000 0004 0373 3971, GRID grid.136593.b, Department of Traumatology and Acute Critical Medicine, , Osaka University Graduate School of Medicine, ; Suita, Japan

[3 ]ISNI 0000 0004 0596 6533, GRID grid.411102.7, Department of anesthesiology, , Kobe University Hospital, ; Kobe, Japan

[4 ]ISNI 0000 0004 1936 9959, GRID grid.26091.3c, Center for General Medicine Education, , Keio University School of Medicine, ; Tokyo, Japan

[5 ]ISNI 0000 0004 0378 2140, GRID grid.414927.d, Department of Intensive Care Medicine, , Kameda Medical Center, ; Kamogawa, Japan

[6 ]ISNI 0000 0004 1762 2738, GRID grid.258269.2, Department of Emergency and Disaster Medicine, , Juntendo University Graduate School of Medicine, ; Tokyo, Japan

[7 ]ISNI 0000 0001 0663 3325, GRID grid.410793.8, Department of Anesthesiology and Critical Care Medicine, , Tokyo Medical University School of Medicine, ; Tokyo, Japan

[8 ]ISNI 0000 0004 1774 0400, GRID grid.412762.4, Department of Emergency and Critical Care Medicine, , Tokai University Hachioji Hospital, ; Tokyo, Japan

[9 ]ISNI 0000 0001 1167 1801, GRID grid.258333.c, Department of Emergency and Intensive Care Medicine, , Kagoshima University Graduate School of Medical and Dental Sciences, ; Kagoshima, Japan

[10 ]ISNI 0000 0001 1092 3077, GRID grid.31432.37, Department of Disaster and Emergency Medicine, , Kobe University Graduate School of Medicine, ; Kobe, Japan

[11 ]ISNI 0000 0001 2248 6943, GRID grid.69566.3a, Division of Emergency and Critical Care Medicine, , Tohoku University Graduate School of Medicine, ; Sendai, Japan

[12 ]ISNI 0000 0001 0691 0855, GRID grid.263171.0, Department of Intensive Care Medicine, , Sapporo Medical University School of Medicine, ; Sapporo, Japan

[13 ]ISNI 0000 0001 0943 978X, GRID grid.27476.30, Department of Emergency & Critical Care Medicine, , Nagoya University Graduate School of Medicine, ; Nagoya, Japan

[14 ]ISNI 0000 0001 0728 1069, GRID grid.260433.0, Department of Advancing Acute Medicine, , Nagoya City University Graduate School of Medical Sciences, ; Nagoya, Japan

[15 ]ISNI 0000 0004 0370 1101, GRID grid.136304.3, Department of Emergency and Critical Care Medicine, , Chiba University Graduate School of Medicine, ; Chiba, Japan

[16 ]ISNI 0000 0004 0377 2305, GRID grid.63906.3a, Division of Critical Care Medicine, , National Center for Child Health and Development, ; Tokyo, Japan

[17 ]ISNI 0000000123090000, GRID grid.410804.9, Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, , Jichi Medical University School of Medicine, ; Shimotsuke, Japan

[18 ]ISNI 0000 0001 0720 6587, GRID grid.410818.4, Department of Emergency and Critical Care Medicine, , Tokyo Women’s Medical University Yachiyo Medical Center, ; Tokyo, Japan

[19 ]ISNI 0000 0000 8711 3200, GRID grid.257022.0, Department of Emergency and Critical Care Medicine, Institute of Biomedical & Health Sciences, , Hiroshima University, ; Higashihiroshima, Japan

[20 ]Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kochi, Japan

[21 ]ISNI 0000 0004 1936 9959, GRID grid.26091.3c, Department of Emergency and Critical Care Medicine, School of Medicine, , Keio University, ; Tokyo, Japan

[22 ]ISNI 000000041936754X, GRID grid.38142.3c, Department of Surgery, Beth Israel Deaconess Medical Center, , Harvard Medical School, ; Boston, USA

[23 ]Healthcare New Frontier Promotion Headquarters Office, Kanagawa Prefectural Government, Yokohama, Japan

[24 ]ISNI 0000 0004 0473 9646, GRID grid.42327.30, Department of Anesthesia and Pain Medicine, , The Hospital for Sick Children, ; Toronto, Canada

[25 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Department of Anesthesia, Faculty of Medicine, , University of Toronto, ; Toronto, Canada

[26 ]ISNI 0000 0001 2149 8846, GRID grid.260969.2, Division of Emergency and Critical Care Medicine, Departmen of Acute Medicine, , Nihon university school of Medicine, ; Tokyo, Japan

[27 ]ISNI 0000 0001 2151 536X, GRID grid.26999.3d, Department of Acute Medicine, , The University of Tokyo, ; Tokyo, Japan

[28 ]ISNI 0000 0004 1762 0759, GRID grid.411951.9, Department of Anesthesiology and Intensive Care, , Hamamatsu University School of Medicine, ; Hamamatsu, Japan

[29 ]ISNI 0000 0004 0641 2620, GRID grid.416523.7, Department of Anesthesiology, , St. Mary’s Hospital, ; Westminster, UK

[30 ]GRID grid.488554.0, Division of Infectious Diseases and Infection Control, , Tohoku Medical and Pharmaceutical University Hospital, ; Sendai, Japan

[31 ]ISNI 000000041936754X, GRID grid.38142.3c, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, , Harvard Medical School, ; Boston, USA

[32 ]ISNI 0000 0001 0665 3553, GRID grid.412334.3, Department of Anesthesiology and Intensive Care, Faculty of Medicine, , Oita University, ; Oita, Japan

[33 ]ISNI 0000 0004 0619 0044, GRID grid.412814.a, Department of Emergency and Intensive Care Medicine, Mito Clinical Education and Training Center, , Tsukuba University Hospital, Mito Kyodo General Hospital, ; Mito, Japan

[34 ]ISNI 0000 0001 0667 4960, GRID grid.272458.e, Department of Anesthesiology and Intensive Care Medicine, , Kyoto Prefectural University of Medicine, ; Tsukuba, Japan

[35 ]Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan

[36 ]ISNI 0000 0004 0378 6088, GRID grid.412167.7, Emergency and Critical Care Center, , Hokkaido University Hospital, ; Sapporo, Japan

[37 ]GRID grid.471800.a, Emergency Medical Center, , Kagawa University Hospital, ; Miki, Japan

[38 ]Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe City Hospital Organization, Kobe, Japan

[39 ]ISNI 0000 0004 1774 580X, GRID grid.459677.e, Department of Pediatrics, , Kumamoto Red cross Hospital, ; Kumamoto, Japan

[40 ]ISNI 0000 0004 1774 8373, GRID grid.416980.2, Emergency and Critical Care Medical Center, , Osaka Police Hospital, ; Osaka, Japan

[41 ]Department of Emergency & ICU, Steel Memorial Yawata Hospital, Kitakyushu, Japan

[42 ]ISNI 0000 0000 9206 2938, GRID grid.410786.c, Department of Emergency & Critical Care Medicine Kitasato University, ; Tokyo, Japan

[43 ]ISNI 0000 0004 0378 1551, GRID grid.415798.6, Department of Pediatric Critical Care, , Shizuoka Children’s Hospital, ; Shizuoka, Japan

[44 ]ISNI 0000 0004 0471 5871, GRID grid.416691.d, Department of Anesthesia, , Obihiro Kosei Hospital, ; Obihiro, Japan

[45 ]ISNI 0000 0004 0596 7077, GRID grid.416273.5, Department of Surgery, , Nippon Medical School Chiba Hokusoh Hospital, ; Inzai, Japan

[46 ]ISNI 0000 0004 0378 2191, GRID grid.412772.5, Department of Emergency and Critical Care Medicine, , Tokushima University Hospital, ; Tokushima, Japan

[47 ]ISNI 0000000122483208, GRID grid.10698.36, Department of Epidemiology, , University of North Carolina Gillings School of Global Public Health, ; Chapel Hill, USA

[48 ]ISNI 0000 0000 9269 4097, GRID grid.256642.1, Department of Emergency Medicine, , Gunma University Graduate School of Medicine, ; Maebashi, Japan

[49 ]ISNI 0000 0004 0596 7077, GRID grid.416273.5, Shock and Trauma Center, , Nippon Medical School Chiba Hokusoh Hospital, ; Inzai, Japan

[50 ]ISNI 0000 0004 1769 1784, GRID grid.482668.6, Department of Emergency and Critical Care Medicine, , Juntendo University Nerima Hospital, ; Tokyo, Japan

[51 ]ISNI 0000 0004 0378 1009, GRID grid.414159.c, Department of Emergency and Intensive Care Medicine, , JA Hiroshima General Hospital, ; Hatsukaichi, Japan

[52 ]Department of Intensive Care Medicine, Nakagami Hospital, Uruma, Japan

[53 ]ISNI 0000 0001 1011 3808, GRID grid.255464.4, Department of Aeromedical Services for Emergency and Trauma Care, , Ehime University Graduate School of Medicine, ; Matsuyama, Japan

[54 ]ISNI 0000 0001 2173 7691, GRID grid.39158.36, Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, , Hokkaido University Graduate School of Medicine, ; Sapporo, Japan

[55 ]ISNI 0000 0000 9142 153X, GRID grid.272264.7, Department of Emergency and Critical Care Medicine, , Hyogo College of Medicine, ; Nishinomiya, Japan

[56 ]Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan

[57 ]Department of Intensive Care Medicine, Osaka Women’s and Children’s Hospital, Osaka, Japan

[58 ]ISNI 0000 0004 0378 2140, GRID grid.414927.d, Department of Intensive Care Medicine, , Kameda Medical Center, ; Kamogawa, Japan

[59 ]ISNI 0000 0001 2308 3329, GRID grid.9707.9, Department of Anesthesiology and Intensive Care Medicine, , Kanazawa University, ; Kanazawa, Japan

[60 ]GRID grid.413010.7, Advanced Medical Emergency and Critical Care Center, , Yamaguchi University Hospital, ; Ube, Japan

[61 ]ISNI 0000 0001 0691 0855, GRID grid.263171.0, Department of Diagnostic Radiology, , Sapporo Medical University School of Medicine, ; Sapporo, Japan

[62 ]Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan

[63 ]ISNI 0000 0004 0372 2033, GRID grid.258799.8, Department of Healthcare Economics and Quality Management, Graduate School of Medicine, , Kyoto University, ; Kyoto, Japan

[64 ]ISNI 0000 0004 0403 4283, GRID grid.412398.5, Intensive Care Unit, , Osaka University Hospital, ; Osaka, Japan

Article

Publisher ID: 270

DOI: 10.1186/s40560-017-0270-8

PMC ID: 5797365

PubMed ID: 29435330

SO-VID: 97414445-372c-43f8-9db0-b0c5c621ac3e

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 8 December 2017

Date accepted : 11 December 2017

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Keywords: sepsis,septic shock,guidelines,evidence-based medicine,systematic review,medical information network distribution service (minds)

Data availability:

Keywords: sepsis, septic shock, guidelines, evidence-based medicine, systematic review, medical information network distribution service (minds)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016)

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Abstract

Background and purpose

Methods

Results

Conclusions

Electronic supplementary material

Related collections

Citation Behaviour and Practice

Most cited references 346

Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.

Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial.

Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.

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