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

Abstract

Background and purposeThe 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.MethodsMembers 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.ResultsA 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.ConclusionsBased 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 materialThe online version of this article (10.1186/s40560-017-0270-8) contains supplementary material, which is available to authorized users.

Diagnosis and management of sepsis‐induced coagulopathy and disseminated intravascular coagulation

“…Several large observational studies have consistently demonstrated favorable effects of antithrombin supplementation in septic patients with DIC . Accordingly, the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock recommends the use of antithrombin to DIC patients with decreased antithrombin activity, although this practice is not common outside of Japan.…”

The anticoagulant treatment for sepsis induced disseminated intravascular coagulation; network meta-analysis

“…However, the Japanese Clinical Practice The above controversies on the use of antithrombin may be explained by the KyberSept trial [5]. Umemura [7] and the J-SSCG2016 [30] used the results of subgroup analysis of the KyberSept study conducted on septic DIC patients by Kienast et al [21]. In contrast, Allingstrup [6] used the results of the whole cohort in the KyberSept study [5], which suggested the increase of risk of bleeding complication without any significant effect on mortality for the use of antithrombin.…”

“…The use of thrombomodulin for Septic DIC In SSCG 2016 [4], there was no recommendation for the use of thrombomodulin in septic patients. In J-SSCG2016, there is no clear recommendation for the use of thrombomodulin in sepsis-associated DIC (Level B, expert consensus) [30]. The ISTH had recommended to use thrombomodulin in DIC patients (potentially recommended) [29].…”

“…Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG2016) recommended not using heparin as a standard treatment in sepsis-associated DIC (Level D, expert consensus)[30]. There was no recommendation for the use of heparin in the 2016 Surviving Sepsis Campaign guidelines[4].In 2015, Zarychanski et al conducted a systematic review and reported that the use of heparin tended to decrease mortality [RR, 0.88 (95% CI, 0.77-1.00), p=0.05] without a risk for major bleeding [RR, 0.79 (95% CI, 0.53-1.17)] compared with a placebo or usual care in septic patients[9].…”

“…This RCT was excluded from our analysis because not all the patients were critically ill or admitted to the ICU. In the meta-analysis conducted in the J-SSCG2016, the use of heparin did not affect the28-day mortality rate [RR 1.13, (95% CI, 0.62-2.06), p=0.69], and had a non-significant tendency to increase the incidence of bleeding complications [RR 2.84, (95% CI, 0.27-29.88), p=0.38][30]. Similar results were reported in a metaanalysis conducted by Umemura et al[7].…”