{"id":526,"date":"2025-01-24T16:46:31","date_gmt":"2025-01-24T16:46:31","guid":{"rendered":"https:\/\/perfusfind.com\/ic\/?p=526"},"modified":"2025-01-24T16:46:31","modified_gmt":"2025-01-24T16:46:31","slug":"management-of-adult-sepsis-in-resource-limited-settings-global-expert-consensus-statements-using-a-delphi-method","status":"publish","type":"post","link":"https:\/\/perfusfind.com\/ic\/index.php\/2025\/01\/24\/management-of-adult-sepsis-in-resource-limited-settings-global-expert-consensus-statements-using-a-delphi-method\/","title":{"rendered":"Management of adult sepsis in resource-limited settings: global expert consensus statements using a Delphi method"},"content":{"rendered":"

Abstract<\/h2>\n
\n

Purpose<\/h3>\n

To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings.<\/p>\n

Methods<\/h3>\n

An international multidisciplinary Steering Committee with expertise\u00a0in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the final consensus statements.<\/p>\n

Results<\/h3>\n

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 escalating 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 refill time and urine output may be used to guide resuscitation; special considerations regarding the volume of fluid used for resuscitation, especially in tropical infections, including the use of simple tests to assess fluid responsiveness when facilities for advanced hemodynamic monitoring are limited; use of Ringer\u2019s lactate or Hartmann\u2019s solution as balanced salt solutions; epinephrine 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.<\/p>\n

Conclusion<\/h3>\n

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 resource-limited settings. These statements complement existing guidelines where evidence is lacking and add relevant aspects of sepsis management that are not addressed by current international guidelines. Future studies are needed to assess the effects of these practice statements and address remaining uncertainties.<\/p>\n

Key Points<\/strong><\/p><\/blockquote>\n

    \n
  1. Sepsis Burden in LMICs<\/strong>: LMICs bear 85% of the global sepsis burden, with unique challenges like different etiologies, comorbidities, and limited healthcare infrastructure.<\/li>\n
  2. Delphi Process<\/strong>: Four survey rounds achieved consensus on 94% of statements, resulting in 23 expert clinical practice guidelines tailored for resource-limited settings.<\/li>\n
  3. Diagnosis and Monitoring<\/strong>: In the absence of serum lactate, parameters like capillary refill time, urine output, and altered mental status are effective alternatives.<\/li>\n
  4. Antimicrobial Guidance<\/strong>: Empirical antibiotics should be administered without delay when sepsis is suspected, alongside antiparasitic agents in endemic areas.<\/li>\n
  5. Fluid Resuscitation<\/strong>: Special considerations for tropical infections and the use of balanced salt solutions (e.g., Ringer\u2019s lactate) are highlighted to avoid complications from fluid overload.<\/li>\n
  6. Vasopressor Use<\/strong>: Epinephrine is an acceptable alternative to norepinephrine and vasopressin, and vasopressors can be safely initiated peripherally when central access is unavailable.<\/li>\n
  7. Alternative Care Settings<\/strong>: Guidance on managing sepsis outside ICUs includes the use of telemedicine, basic imaging tools, and simplified monitoring protocols.<\/li>\n
  8. Respiratory Support<\/strong>: Non-invasive ventilation (NIV) is recommended as an alternative to high-flow nasal oxygen (HFNO) when the latter is unavailable.<\/li>\n
  9. Ethical and Socioeconomic Factors<\/strong>: Recommendations account for socioeconomic disparities, education levels, and access challenges common in LMICs.<\/li>\n
  10. Research Priorities<\/strong>: The study identifies the need for context-specific research to refine antimicrobial regimens, fluid management strategies, and monitoring techniques.<\/li>\n<\/ol>\n

    ACCESS FULL ARTICLE HERE<\/strong><\/a><\/p>\n

    Open Access<\/b>\u00a0This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit\u00a0http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/<\/a>.<\/p>\n

     <\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Abstract Purpose To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings. Methods An international multidisciplinary Steering Committee with expertise\u00a0in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with […]<\/p>\n","protected":false},"author":1,"featured_media":533,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[5],"tags":[208,204,206,114,205,207],"class_list":["post-526","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sepsis","tag-anti-infective-agents","tag-delphi","tag-delphi-methodology","tag-sepsis","tag-sepsis-management","tag-vasoactive-agents"],"yoast_head":"\nManagement of adult sepsis in resource-limited settings: global expert consensus statements using a Delphi method - 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Methods An international multidisciplinary Steering Committee with expertise\u00a0in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with…","_links":{"self":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/526","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/comments?post=526"}],"version-history":[{"count":1,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/526\/revisions"}],"predecessor-version":[{"id":534,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/526\/revisions\/534"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/media\/533"}],"wp:attachment":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/media?parent=526"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/categories?post=526"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/tags?post=526"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}