Guidelines for Complications of Cancer Treatment Vol VIII Part B

Consideration for limitation of supporto Discuss advance care planning with patients andfamilies. Describe likely outcomes and set realisticexpectations (1D) S2004 EDellinger RP, Levy MM, Carlet JM, et al for theInternational Surviving Sepsis Campaign GuidelinesCommittee. Surviving Sepsis Campaign: internationalguidelines for management of severe sepsis and septicshock: 2008. Crit Care Med 2008; 36: 296–327 and IntCare Med. 2008; 34: 17-60.OBJECTIVE: To provide an update to the original SurvivingSepsis Campaign clinical management guidelines, “SurvivingSepsis Campaign guidelines for management of severe sepsisand septic shock,” published in 2004. DESIGN: ModifiedDelphi method with a consensus conference of 55 internationalexperts, several subsequent meetings of subgroups and keyindividuals, teleconferences, and electronic-based discussionamong subgroups and among the entire committee. Thisprocess was conducted independently of any industry funding.METHODS: We used the GRADE system to guide assessmentof quality of evidence from high (A) to very low (D) and todetermine the strength of recommendations. A strongrecommendation indicates that an intervention’s desirableeffects clearly outweigh its undesirable effects (risk, burden,cost), or clearly do not. Weak recommendations indicate thatthe tradeoff between desirable and undesirable effects is lessclear. The grade of strong or weak is considered of greaterclinical importance than a difference in letter level of qualityof evidence. In areas without complete agreement, a formalprocess of resolution was developed and applied.Recommendations are grouped into those directly targetingsevere sepsis, recommendations targeting general care of the86