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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)</title><author><name sortKey="Singer, Mervyn" sort="Singer, Mervyn" uniqKey="Singer M" first="Mervyn" last="Singer">Mervyn Singer</name></author><author><name sortKey="Deutschman, Clifford S" sort="Deutschman, Clifford S" uniqKey="Deutschman C" first="Clifford S." last="Deutschman">Clifford S. Deutschman</name></author><author><name sortKey="Seymour, Christopher Warren" sort="Seymour, Christopher Warren" uniqKey="Seymour C" first="Christopher Warren" last="Seymour">Christopher Warren Seymour</name></author><author><name sortKey="Shankar Hari, Manu" sort="Shankar Hari, Manu" uniqKey="Shankar Hari M" first="Manu" last="Shankar-Hari">Manu Shankar-Hari</name></author><author><name sortKey="Annane, Djillali" sort="Annane, Djillali" uniqKey="Annane D" first="Djillali" last="Annane">Djillali Annane</name></author><author><name sortKey="Bauer, Michael" sort="Bauer, Michael" uniqKey="Bauer M" first="Michael" last="Bauer">Michael Bauer</name></author><author><name sortKey="Bellomo, Rinaldo" sort="Bellomo, Rinaldo" uniqKey="Bellomo R" first="Rinaldo" last="Bellomo">Rinaldo Bellomo</name></author><author><name sortKey="Bernard, Gordon R" sort="Bernard, Gordon R" uniqKey="Bernard G" first="Gordon R." last="Bernard">Gordon R. Bernard</name></author><author><name sortKey="Chiche, Jean Daniel" sort="Chiche, Jean Daniel" uniqKey="Chiche J" first="Jean-Daniel" last="Chiche">Jean-Daniel Chiche</name></author><author><name sortKey="Coopersmith, Craig M" sort="Coopersmith, Craig M" uniqKey="Coopersmith C" first="Craig M." last="Coopersmith">Craig M. Coopersmith</name></author><author><name sortKey="Hotchkiss, Richard S" sort="Hotchkiss, Richard S" uniqKey="Hotchkiss R" first="Richard S." last="Hotchkiss">Richard S. Hotchkiss</name></author><author><name sortKey="Levy, Mitchell M" sort="Levy, Mitchell M" uniqKey="Levy M" first="Mitchell M." last="Levy">Mitchell M. Levy</name></author><author><name sortKey="Marshall, John C" sort="Marshall, John C" uniqKey="Marshall J" first="John C." last="Marshall">John C. Marshall</name></author><author><name sortKey="Martin, Greg S" sort="Martin, Greg S" uniqKey="Martin G" first="Greg S." last="Martin">Greg S. Martin</name></author><author><name sortKey="Opal, Steven M" sort="Opal, Steven M" uniqKey="Opal S" first="Steven M." last="Opal">Steven M. Opal</name></author><author><name sortKey="Rubenfeld, Gordon D" sort="Rubenfeld, Gordon D" uniqKey="Rubenfeld G" first="Gordon D." last="Rubenfeld">Gordon D. Rubenfeld</name></author><author><name sortKey="Van Der Poll, Tom" sort="Van Der Poll, Tom" uniqKey="Van Der Poll T" first="Tom" last="Van Der Poll">Tom Van Der Poll</name></author><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name></author><author><name sortKey="Angus, Derek C" sort="Angus, Derek C" uniqKey="Angus D" first="Derek C." last="Angus">Derek C. Angus</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26903338</idno><idno type="pmc">4968574</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968574</idno><idno type="RBID">PMC:4968574</idno><idno type="doi">10.1001/jama.2016.0287</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">001F44</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001F44</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)</title><author><name sortKey="Singer, Mervyn" sort="Singer, Mervyn" uniqKey="Singer M" first="Mervyn" last="Singer">Mervyn Singer</name></author><author><name sortKey="Deutschman, Clifford S" sort="Deutschman, Clifford S" uniqKey="Deutschman C" first="Clifford S." last="Deutschman">Clifford S. Deutschman</name></author><author><name sortKey="Seymour, Christopher Warren" sort="Seymour, Christopher Warren" uniqKey="Seymour C" first="Christopher Warren" last="Seymour">Christopher Warren Seymour</name></author><author><name sortKey="Shankar Hari, Manu" sort="Shankar Hari, Manu" uniqKey="Shankar Hari M" first="Manu" last="Shankar-Hari">Manu Shankar-Hari</name></author><author><name sortKey="Annane, Djillali" sort="Annane, Djillali" uniqKey="Annane D" first="Djillali" last="Annane">Djillali Annane</name></author><author><name sortKey="Bauer, Michael" sort="Bauer, Michael" uniqKey="Bauer M" first="Michael" last="Bauer">Michael Bauer</name></author><author><name sortKey="Bellomo, Rinaldo" sort="Bellomo, Rinaldo" uniqKey="Bellomo R" first="Rinaldo" last="Bellomo">Rinaldo Bellomo</name></author><author><name sortKey="Bernard, Gordon R" sort="Bernard, Gordon R" uniqKey="Bernard G" first="Gordon R." last="Bernard">Gordon R. Bernard</name></author><author><name sortKey="Chiche, Jean Daniel" sort="Chiche, Jean Daniel" uniqKey="Chiche J" first="Jean-Daniel" last="Chiche">Jean-Daniel Chiche</name></author><author><name sortKey="Coopersmith, Craig M" sort="Coopersmith, Craig M" uniqKey="Coopersmith C" first="Craig M." last="Coopersmith">Craig M. Coopersmith</name></author><author><name sortKey="Hotchkiss, Richard S" sort="Hotchkiss, Richard S" uniqKey="Hotchkiss R" first="Richard S." last="Hotchkiss">Richard S. Hotchkiss</name></author><author><name sortKey="Levy, Mitchell M" sort="Levy, Mitchell M" uniqKey="Levy M" first="Mitchell M." last="Levy">Mitchell M. Levy</name></author><author><name sortKey="Marshall, John C" sort="Marshall, John C" uniqKey="Marshall J" first="John C." last="Marshall">John C. Marshall</name></author><author><name sortKey="Martin, Greg S" sort="Martin, Greg S" uniqKey="Martin G" first="Greg S." last="Martin">Greg S. Martin</name></author><author><name sortKey="Opal, Steven M" sort="Opal, Steven M" uniqKey="Opal S" first="Steven M." last="Opal">Steven M. Opal</name></author><author><name sortKey="Rubenfeld, Gordon D" sort="Rubenfeld, Gordon D" uniqKey="Rubenfeld G" first="Gordon D." last="Rubenfeld">Gordon D. Rubenfeld</name></author><author><name sortKey="Van Der Poll, Tom" sort="Van Der Poll, Tom" uniqKey="Van Der Poll T" first="Tom" last="Van Der Poll">Tom Van Der Poll</name></author><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name></author><author><name sortKey="Angus, Derek C" sort="Angus, Derek C" uniqKey="Angus D" first="Derek C." last="Angus">Derek C. Angus</name></author></analytic><series><title level="j">JAMA</title><idno type="ISSN">0098-7484</idno><idno type="eISSN">1538-3598</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>IMPORTANCE</title><p id="P1">Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.</p></sec><sec id="S2"><title>OBJECTIVE</title><p id="P2">To evaluate and, as needed, update definitions for sepsis and septic shock.</p></sec><sec id="S3"><title>PROCESS</title><p id="P3">A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment).</p></sec><sec id="S4"><title>KEY FINDINGS FROMEVIDENCE SYNTHESIS</title><p id="P4">Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term <italic>severe sepsis</italic> was redundant.</p></sec><sec id="S5"><title>RECOMMENDATIONS</title><p id="P5">Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mm Hg or less.</p></sec><sec id="S6"><title>CONCLUSIONS AND RELEVANCE</title><p id="P6">These updated definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">7501160</journal-id><journal-id journal-id-type="pubmed-jr-id">5346</journal-id><journal-id journal-id-type="nlm-ta">JAMA</journal-id><journal-id journal-id-type="iso-abbrev">JAMA</journal-id><journal-title-group><journal-title>JAMA</journal-title></journal-title-group><issn pub-type="ppub">0098-7484</issn><issn pub-type="epub">1538-3598</issn></journal-meta><article-meta><article-id pub-id-type="pmid">26903338</article-id><article-id pub-id-type="pmc">4968574</article-id><article-id pub-id-type="doi">10.1001/jama.2016.0287</article-id><article-id pub-id-type="manuscript">NIHMS794087</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Singer</surname><given-names>Mervyn</given-names></name><degrees>MD, FRCP</degrees></contrib><contrib contrib-type="author"><name><surname>Deutschman</surname><given-names>Clifford S.</given-names></name><degrees>MD, MS</degrees></contrib><contrib contrib-type="author"><name><surname>Seymour</surname><given-names>Christopher Warren</given-names></name><degrees>MD, MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Shankar-Hari</surname><given-names>Manu</given-names></name><degrees>MSc, MD, FFICM</degrees></contrib><contrib contrib-type="author"><name><surname>Annane</surname><given-names>Djillali</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Bauer</surname><given-names>Michael</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Bellomo</surname><given-names>Rinaldo</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Bernard</surname><given-names>Gordon R.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Chiche</surname><given-names>Jean-Daniel</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Coopersmith</surname><given-names>Craig M.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Hotchkiss</surname><given-names>Richard S.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Levy</surname><given-names>Mitchell M.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Marshall</surname><given-names>John C.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Martin</surname><given-names>Greg S.</given-names></name><degrees>MD, MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Opal</surname><given-names>Steven M.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Rubenfeld</surname><given-names>Gordon D.</given-names></name><degrees>MD, MS</degrees></contrib><contrib contrib-type="author"><name><surname>van der Poll</surname><given-names>Tom</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Vincent</surname><given-names>Jean-Louis</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Angus</surname><given-names>Derek C.</given-names></name><degrees>MD, MPH</degrees></contrib><aff id="A1">Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom (Singer); Hofstra–Northwell School of Medicine, Feinstein Institute for Medical Research, New Hyde Park, New York (Deutschman); Department of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Seymour); Department of Critical Care Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (Shankar-Hari); Department of Critical Care Medicine, University of Versailles, France (Annane); Center for Sepsis Control and Care, University Hospital, Jena, Germany (Bauer); Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, and Austin Hospital, Melbourne, Victoria, Australia (Bellomo); Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University, Nashville, Tennessee (Bernard); Reanimation Medicale-Hopital Cochin, Descartes University, Cochin Institute, Paris, France (Chiche); Critical Care Center, Emory University School of Medicine, Atlanta, Georgia (Coopersmith);Washington University School of Medicine, St Louis, Missouri (Hotchkiss); Infectious Disease Section, Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, Rhode Island (Levy, Opal); Department of Surgery, University of Toronto, Toronto, Ontario, Canada (Marshall); Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia (Martin); Trauma, Emergency & Critical Care Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Rubenfeld); Interdepartmental Division of Critical Care, University of Toronto (Rubenfeld); Department of Infectious Diseases, Academisch Medisch Centrum, Amsterdam, the Netherlands (van der Poll); Department of Intensive Care, Erasme University Hospital, Brussels, Belgium (Vincent); Department of Critical Care Medicine, University of Pittsburgh and UPMC Health System, Pittsburgh, Pennsylvania (Angus); Associate Editor,<italic>JAMA</italic> (Angus).</aff></contrib-group><author-notes><corresp id="cor1"><bold>Corresponding Author:</bold> Clifford S. Deutschman, MD,MS, Departments of Pediatrics and Molecular Medicine, Hofstra–Northwell School of Medicine, Feinstein Institute for Medical Research, 269-01 76th Ave, New Hyde Park, NY 11040 (<email>cdeutschman@nshs.edu</email>)</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>10</day><month>6</month><year>2016</year></pub-date><pub-date pub-type="ppub"><day>23</day><month>2</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>8</month><year>2016</year></pub-date><volume>315</volume><issue>8</issue><fpage>801</fpage><lpage>810</lpage><pmc-comment>elocation-id from pubmed: 10.1001/jama.2016.0287</pmc-comment>
<abstract><sec id="S1"><title>IMPORTANCE</title><p id="P1">Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.</p></sec><sec id="S2"><title>OBJECTIVE</title><p id="P2">To evaluate and, as needed, update definitions for sepsis and septic shock.</p></sec><sec id="S3"><title>PROCESS</title><p id="P3">A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment).</p></sec><sec id="S4"><title>KEY FINDINGS FROMEVIDENCE SYNTHESIS</title><p id="P4">Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term <italic>severe sepsis</italic> was redundant.</p></sec><sec id="S5"><title>RECOMMENDATIONS</title><p id="P5">Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mm Hg or less.</p></sec><sec id="S6"><title>CONCLUSIONS AND RELEVANCE</title><p id="P6">These updated definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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