Key changes in the methodology of development of this revision of Surviving Sepsis Campaign guidelines

Sepsis is a common clinical syndrome characterized by infection accompanied by systemic inflammation. The systemic inflammation (systemic inflammatory response syndrome – SIRS), which may be also related to non-infectious causes (Fig. 1), manifests itself as changes in temperature (>38oC or <36oC), tachycardia (>90 per minute), tachypnea (>20 per minute), or changes in white blood cell count in peripheral blood (<4000 or >12,000 cells per μl, or >10% immature forms of granulocytes [bands]). More recent publications point to other systemic manifestations of infection than the four original SIRS criteria, although lists of such manifestations are more difficult to use in clinical practise than the original SIRS definition (Appendix) [1,2]. Once symptoms of tissue hypo perfusion (elevated lactate or altered mental status), arterial hypotension, or other organ dysfunction occur due to the systemic manifestations of infection we are dealing with severe sepsis; when blood pressure remains decreased despite adequate fluid resuscitation we are faced with septic shock (Fig. 1) [2]. Well over half a million patients in the USA develop severe sepsis each year. The mortality from severe sepsis or septic shock varies according to the severity of condition from 15% to over 50%. No other clinical syndrome occurs so often, so suddenly, and with such devastating results at the same time. It is estimated that in the US alone over 200,000 patients die each year sepsis and almost as many in Europe [1,3]. Extrapolating this number to Polish population would put the number of deaths at about 15,000 per year. The recognition of the importance of severe sepsis and septic shock continues to grow. A group of clinicians interested in the sepsis management representing eleven international organizations came together in early 2000s to develop „Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock” first published in 2004 [4]. The recently published 2008 revision represents the most recent effort of this group, now sponsored by fourteen international organizations [5].