Chest
Volume 101, Issue 6, June 1992, Pages 1644-1655
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ACCP/SCCM Consensus Conference
Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis

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An American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae. New definitions were offered for some terms, while others were discarded. Broad definitions of sepsis and the systemic inflammatory response syndrome were proposed, along with detailed physiologic parameters by which a patient may be categorized. Definitions for severe sepsis, septic shock, hypotension, and multiple organ dysfunction syndrome were also offered. The use of severity scoring methods when dealing with septic patients was recommended as an adjunctive tool to assess mortality. Appropriate methods and applications for the use and testing of new therapies were recommended. The use of these terms and techniques should assist clinicians and researchers who deal with sepsis and its sequelae.

Section snippets

Sepsis

The systemic response to infection has been termed sepsis.1, 2 Sepsis is an increasingly common cause of morbidity and mortality, particularly in elderly, immunocompromised, and critically ill patients.1, 3, 4, 5 Sepsis has been reported to be the most common cause of death in the noncoronary intensive care unit.4, 6 Its rising incidence, new etiologies, and appearance in new populations of patients have been related to changing demographics and the increased use of more potent and

Multiple Organ Dysfunction Syndrome

The increasing incidence of morbidity and mortality caused by multiple organ failure has paralleled improvements in the life-support technologies available to patients admitted to an intensive care unit (ICU). As newer technologies for the monitoring and support of patients sustaining life-threatening critical illness became established, retrospective clinical studies found that a major threat to survival was not the underlying illness, or even a single complication thereof, but rather a

Severity-of-Illness Scoring System

A common theme in the two previous sections of this consensus statement is that we are treating more severely ill patients at later stages of illness. It is also apparent that many of these patients who have more complex illnesses may be suffering from a combination of chronic and acute disease. The nature of disease presentation is changing, and patient or host response is exemplified by the proposed introduction of new syndromes, such as SIRS and MODS. The recognition and treatment of these

Guidelines for the Use of Innovative Therapies in Severe Sepsis

Innovative therapy in severe sepsis usually involves an attempt to alter the systemic inflammatory response of a patient. Such forms of therapy are quite different from supportive therapy or therapies that are directed at the causative organism (eg, antibiotics or surgical procedures). Despite the use of these current therapies, the morbidity and mortality rates in severe sepsis remain high. Over the last 10 to 15 years, new antibiotics and increasingly sophisticated critical care have had

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    Manuscript received September 23; revision accepted January 22.

    THE ACCP/SCCM CONSENSUS CONFERENCE COMMITTEE:

    Conference Chairman:

    Roger C. Bone M.D., F.C.C.P., Dean, Rush Medical College; Vice-President for Medical Affairs, Rush-Presbyterian-St. Luke's Medical Center, Chicago

    Session Chairmen:

    Robert A. Balk, M.D., F.C.C.P., Associate Professor of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago

    Frank B. Cerra, M.D., Professor of Surgery and Director of Critical Care, Department of Surgery, University of Minnesota Hospital, Minneapolis

    R. Phillip Dellinger, M.D., F.C.C.P., Associate Professor and Director of Critical Care, Department of Medicine, Baylor College of Medicine, Dallas

    Alan M. Fein, M.D., F.C.C.P., Director, Pulmonary and Critical Care Medicine Division, and Associate Professor of Medicine, SUNY Health Science Center, Winthrop-University Hospital, Mineola, NY

    William A Knaus, M.D., Director, PCU Research Unit, George Washington University, Washington, DC

    Roland M. H. Schein, M.D., Director of Critical Care Medicine and Associate Professor of Medicine, Department of Veterans Affairs Medical Center, University of Miami School of Medicine, Miami

    William J. Sibbald, M.D., F.C.C.P., Chief, Program in Critical Care, and Professor of Medicine, University of Western Ontario, London, Ontario, Canada

    Faculty:

    Jerome H. Abrams, M.D., Assistant Professor of Surgery, University of Minnesota, Minneapolis

    Gordon R. Bernard, M.D., F.C.C.P., Associate Professor of Medicine, Vanderbilt University Medical School, Nashville James W Biondi, M.D., Pulmonary and Critical Care Section, Yale University School of Medicine, New Haven

    James E. Calvin, Jr., M.D., Associate Professor of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago

    Robert Demling, M.D., Professor of Surgery, Harvard Medical School, Boston

    Patrick J. Fahey, M.D., F.C.C.P., Chief, Pulmonary and Critical Care, Loyola University Medical Center, Maywood, Ill

    Charles J. Fisher, Jr., M.D., Associate Professor and Director, Center for Critical Care Research, Case Western Reserve University, Cleveland

    Cory Franklin, M.D., Associate Professor of Medicine, University of Health Sciences/Chicago Medical School, North Chicago, Ill Kenneth J. Gorelick, M.D., Vice President, Medical and Regulatory Affairs, Genelabs Technologies, Inc, Redwood City, Calif

    Mark A. Kelley, M.D., F.C.C.P., Vice Dean, Clinical Affairs, University of Pennsylvania Medical Center, Philadelphia

    Dennis G. Maki, M.D., F.C.C.P., Professor of Medicine and Head, Section of Infectious Diseases; Attending Physician, Center for Trauma and Life Support, University of Wisconsin Medical School, Madison

    John C. Marshall, M.D., Assistant Professor of Surgery, University of Toronto, and Toronto Hospital, Toronto

    William W Merrill, M.D., Chief, Pulmonary Section, West Haven VA Medical Center, West Haven, Conn

    John P. Pribble, Pharm. D., Assistant Director of Clinical Research, Synergen, Inc, Boulder, Colo

    Eric C. Rackow, M.D., F.C.C.P., Professor and Chairman, Department of Medicine, St. Vincent's Hospital and Medical Center of New York, New York Medical College, New York Timothy C. Rodell, M.D., Vice President, Operations and Product Development, Cortech, Inc, Denver; Clinical Assistant Professor of Medicine, University of Colorado Health Sciences Center, Denver

    John N. Sheagren, M.D., Chairman, Department of Internal Medicine, Illinois Masonic Medical Center; Professor of Medicine, University of Illinois College of Medicine, Chicago Michael Silver, M.D., F.C.C.P., Assistant Professor and Director, Respiratory Care Center, Rush-Presbyterian-St. Luke's Medical Center, Chicago

    Charles L. Sprung, M.D., F.C.C.P., Director, Intensive Care Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel Richard C. Straube, M.D., Director, Infectious Diseases, Centocor, Inc, Malvern, Pa

    Martin J. Tobin, M.D., F.C.C.P., Professor of Medicine, Loyola University of Chicago Stritch School of Medicine, Maywood, Ill Gordon M. Trenholme, M.D., Professor of Medicine, Rush Medical College, Chicago

    Douglas Wagner, M.D., Senior Staff Scientist, ICU Research, George Washington University Medical Center, Washington, DC C. Douglas Webb, Ph.D., Director, Anti-Infectives, Roerig/Pfizer Pharmaceuticals, New York

    Janice C. Wherry, M.D., Ph.D., Associate Director, Clinical Research, Cutter Biological, Miles, Inc, Berkeley, Calif

    Herbert P. Wiedemann, M.D., Chairman, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland

    Cornelius H. Wortel, M.D., Adjunct Clinical Assistant Professor of Medicine, Critical Care/Emergency Medicine Section, Department of Medicine, Ben Taub General Hospital, Houston

    Editors Note: The editorial on page 1481 and this report appear simultaneously in the June, 1992 issue of Critical Care Medicine (20: 724-26; 20: 864-74).

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