Document Type
Article
Department
Anaesthesiology (East Africa)
Abstract
Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resourcelimited settings.
Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacifc Sepsis Alliance (APSA). The committee selected an interna‑ tional panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the fnal consensus statements.
Results: A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include consensus on managing patients with sepsis outside a designated critical care area, triggers for escalat‑ ing clinical management and criteria for safe transfer to another facility. The experts agreed on the following: in the absence of serum lactate, clinical parameters such as altered mental status, capillary refll time and urine output may be used to guide resuscitation; special considerations regarding the volume of fuid used for resuscitation, especially in tropical infections, including the use of simple tests to assess fuid responsiveness when facilities for advanced hemodynamic monitoring are limited; use of Ringer’s lactate or Hartmann’s solution as balanced salt solutions; epi‑ nephrine when norepinephrine or vasopressin are unavailable; and the administration of vasopressors via a peripheral vein if central venous access is unavailable or not feasible. Similarly, where facilities for investigation are unavailable, there was consensus for empirical antimicrobial administration without delay when sepsis was strongly suspected, as was the empirical use of antiparasitic agents in patients with suspicion of parasitic infections.
Conclusion: Using a Delphi method, international experts reached consensus to generate expert clinical practice statements providing guidance to clinicians worldwide on the management of sepsis in resourcelimited settings. These statements complement existing guidelines where evidence is lacking and add relevant aspects of sepsis man‑ agement that are not addressed by current international guidelines. Future studies are needed to assess the efects of these practice statements and address remaining uncertainties.
Publication (Name of Journal)
Intensive Care Medicine
DOI
https://doi.org/10.1007/s00134-024-07735-7
Recommended Citation
Thwaites, L.,
Nasa, P.,
Abbenbroek, B.,
Dat, V. Q.,
Finfer, S.,
Kwizera, A.,
Ling, L.,
Lobo, S. M.,
Sinto, R.,
Siika, W.
(2024). Management of adult sepsis in resource-limited settings: global expert consensus statements using a Delphi method. Intensive Care Medicine, 1-18.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_anaesth/58
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
