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History of the Surviving Sepsis Campaign

Follow a timeline of sepsis research and treatment and the Surviving Sepsis Campaign's development.

Initiated in 2002 at the European Society of Intensive Care Medicine’s (ESICM) annual meeting with the Barcelona Declaration, the Surviving Sepsis Campaign (SSC) has progressed in phases that have developed four editions of evidence-based guidelines, implementation of a performance improvement program, and analysis and publication of data from more than 30,000 patient records collected from around the world.

Below, follow a timeline of sepsis research and treatment and the SSC's development. 

 

1970

  • The pulmonary artery catheter was introduced for bedside measurement of cardiac output and intracardiac pressures, allowing characterization of the hemodynamic profile of septic shock.
  • The link between gram-negative bacteremia, endotoxemia, and manifestations of sepsis was established with the limulus lysate assay.

 

1973

The deleterious clinical impact of infected central IV catheters in the ICU was recognized.

 

1978

Animal models of sepsis emerged.

 

1979

Indirect calorimetry and nitrogen balance were popularized for studying the metabolic response to sepsis.

 

1980

An exotoxin from Staphylococcus aureus was identified as a cause of toxic shock syndrome and linked to tampon use.

 

1984

Profound but reversible myocardial depression was reported in patients with septic shock.

 

1987

  • Critical illness polyneuropathy was recognized, with sepsis as a major risk factor.
  • High-dose methylprednisolone failed to reduce mortality in patients with sepsis and septic shock.

 

1989

The term “sepsis syndrome” was coined to represent infection-induced organ dysfunction.

 

1991

Antimediator therapies showed promise in sepsis animal models, and a study of antiendotoxin therapy found an association with improved outcomes.

 

1992

  • A consensus conference published the first definitions of sepsis.
  • Nitric oxide was named the molecule of the year as its role in the pathophysiology of sepsis continued to be elucidated.

 

1995-1996

The Sequential Organ Failure Assessment (SOFA) score and the Multiple Organ Dysfunction Score (MODS) emerged as inventories to quantify the severity of organ dysfunction in sepsis.

 

1997-1998

Large clinical trials of innovative sepsis therapies were unsuccessful.

 

2001

  • Recombinant human activated protein C (rhAPC) was reported to decrease mortality in severe sepsis.
  • A single-center study demonstrated that early goal-directed therapy (EGDT) improved outcomes in sepsis-induced tissue hypoperfusion.
  • A sepsis definitions conference was held in December 2001 to determine whether new data existed to inform updates to criteria established in 1991 (Levy MM, et al. Crit Care Med. 2003;31:1250-1256)

 

2002

The Society of Critical Care Medicine (SCCM), the European Society of Intensive Care Medicine (ESICM), and the International Sepsis Forum launched the Surviving Sepsis Campaign (SSC). The 2002 Barcelona Declaration set forth a plan to inform the public and government agencies, develop guidelines, and reduce mortality in sepsis.


Replacement therapy with hydrocortisone and fludrocortisone was found to reduce mortality and duration of vasopressor administration in patients with septic shock and relative adrenal insufficiency.

 

 

2003

  • An SSC Executive Committee meeting was held in Amsterdam to plan the guideline development process.
  • A survey of global public awareness of sepsis was presented at SCCM’s 32nd Critical Care Congress in San Antonio, Texas, USA.
  • Representatives of 11 international societies convened to develop guidelines for the management of severe sepsis and septic shock.
  • The SSC initiated a partnership with the Institute for Healthcare Improvement to apply their successful quality improvement techniques to the treatment of sepsis. The SSC bundles evolved from this collaboration.

 

2004

  • The first SSC guidelines for management of severe sepsis and septic shock were published. SSC leadership committed to updates every four years.
  • The SSC Steering Committee convened to determine the direction of data collection activities.
  • SSC was presented to European clinicians at Mediterranean Critical Care School  and international representatives gathered to begin development of SSC bundles.
  • SSC pocket guidelines and posters were developed and distributed by SCCM in North America and ESICM in Europe.
  • Development of the data collection tool began.

 

2005

  • Regional networks were established to promote collaboration in data collection and performance improvement throughout the United States.
  • Implementing the Surviving Sepsis Campaign, the manual for conducting the Campaign in local hospitals, was published.

 

2006

Each hour of delay in administering appropriate antibiotics to patients with septic shock was associated with increased mortality.

  • Approximately 5000 copies of Implementing the Surviving Sepsis Campaign were distributed in North America.
  • An SSC session at SCCM’s 35th Critical Care Congress highlighted data collection.
  • A meeting of representatives from 28 countries was held during the SCCM Congress to begin development of the second edition of the SSC guidelines.

 

2008

A second randomized trial of stress-dose corticosteroids in patients with less severe septic shock failed to validate a mortality reduction associated with replacement therapy.

  • The second edition of the SSC guidelines was published in Critical Care Medicine and Intensive Care Medicine.
  • Performance improvement efforts continued worldwide with data collection, educational programs, and Listserv collaboration.
  • The International Sepsis Forum left the SSC to avoid any misconceptions about industry involvement.

 

2010


Publication of results of 15,000 patient datasets showed the association of SSC bundle compliance with 20% relative risk reduction.

 

2011


The Gordon and Betty Moore Foundation funded development of educational programming, research, and SSC outreach.

 

2012

A follow-up trial of rhAPC administration in patients with septic shock failed to reduce mortality at either 28 or 90 days.


The third edition of the SSC guidelines was published, along with revised bundles.

 

2014

Two large randomized trials of EGDT versus usual care in early septic shock showed no difference in outcomes.

 

2015


An analysis of more than 17,500 patients enrolled in the SSC international performance improvement program demonstrated an association between sepsis bundle compliance and mortality.

 

2016

A third consensus conference published revised definitions of sepsis and septic shock and recommended eliminating the term “severe sepsis.”

 

2017

A World Health Organization resolution recognized sepsis as a global health priority.

 

2018

  • Two large multicenter randomized clinical trials supported the benefit of stress-dose steroids in patients with septic shock who persistently required moderate- to high-dose vasopressors.
  • SCCM commissioned an international task force to formalize and publish a definition of childhood sepsis.

 

2020


The SSC released the first international sepsis guidelines for children.

 

2021

  • The COVID-19 pandemic became the highest priority for ICU care. The SSC released guidelines for the care of critically ill patients with COVID-19.
  • The latest edition of the SSC guidelines for adult patients was released, with increased emphasis on improving the care of sepsis patients after ICU discharge.

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