International multidisciplinary consensus statement on sepsis code guidelines: A Delphi approach

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Healthcare Management

Background:

• Sepsis is a critical global health issue with inconsistent guideline implementation.
• Existing evidence often originates from high-income countries, necessitating broader consensus.
• Sepsis code programs aim to standardize and improve patient care.

Purpose of the Study:

• To achieve international expert consensus on controversial sepsis management topics.
• To inform the development and refinement of sepsis code programs.
• To provide evidence-based guidance applicable across diverse healthcare settings.

Main Methods:

• A multinational modified Delphi study involving 164 experts from 22 countries.
• Evaluation of seven key sepsis management domains through iterative consensus rounds.
• Consensus defined as ≥70% agreement using Likert scales and binary formats.

Main Results:

• Consensus reached on 40 statements regarding sepsis management.
• Strong support for structured sepsis programs, NEWS-2 for early recognition, and procalcitonin biomarker use.
• Agreement on urgent source control, rapid diagnostics, norepinephrine as first-line vasopressor, and dynamic fluid strategies.

Conclusions:

• Multidisciplinary guidance emphasizes rapid recognition, targeted therapy, and physiological hemodynamic management.
• Recommendations support sepsis management in both high- and middle-income healthcare systems.
• The consensus provides a framework for improving sepsis care worldwide.