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Gaps and Strategies for Management of Sepsis in Low-Resource Settings: Expert Consensus Statements Using a Delphi

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Summary

Sepsis care guidelines are needed for low-resource settings (LRS), where most cases occur. An expert panel developed consensus statements to improve sepsis prevention, detection, and management in LRS.

Keywords:
Sepsis managementemergency care frameworksglobal health disparitiesinternational collaborationlow-income countriespublic health policy. low-resource settingstechnology in healthcare

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Area of Science:

  • Critical Care Medicine
  • Global Health
  • Infectious Diseases

Background:

  • Sepsis disproportionately affects low-resource settings (LRS), accounting for nearly 80% of cases.
  • Existing international sepsis management guidelines are often not applicable or fully address the unique challenges in LRS.
  • Limited resources in LRS hinder the effective implementation of standard sepsis care protocols.

Purpose of the Study:

  • To develop consensus-based clinical practice statements for sepsis care tailored to the specific needs of LRS.
  • To address gaps in sepsis prevention, early detection, and management within the framework of the "sepsis chain of survival" in resource-limited environments.
  • To provide guidance for immediate care and future research priorities for sepsis in LRS.

Main Methods:

  • An international panel of 20 multiprofessional sepsis experts was convened.
  • A Delphi process involving iterative, anonymous voting was used to achieve consensus on clinical practice statements.
  • Literature review focused on sepsis management in LRS, utilizing the "sepsis chain of survival" framework.

Main Results:

  • Consensus was achieved on 58 of 62 (94%) proposed clinical practice statements after eight survey rounds.
  • The developed statements provide guidance for improving sepsis prevention, early recognition, and time-sensitive management in LRS.
  • The statements cover the continuum of care from initial response through post-sepsis management and follow-up.

Conclusions:

  • A significant lack of high-quality evidence exists to guide sepsis care improvements in LRS.
  • The consensus statements complement existing international guidelines, offering a basis for immediate sepsis management in LRS.
  • These statements highlight crucial areas for future research to enhance sepsis outcomes in resource-limited settings.