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LAYERS OF THE GUIDELINES The guidelines may be thought of as several concentric layers, similar to an onion (Fig. 1). The outer layer represents the recommendations. A bedside practitioner responsible for immediate decision making and trusting guidelines process will focus on the recommendations. This group of users may find the tables of abbreviated recommendations−the essence of the guidelines condensed to 7 pages−especially useful. The next layer represents the rationales for the recommendations, illuminating the logic—the evidence and the thought—underlying each recommendation. For those who want a more in-depth understanding of how the recommendations were built, the rationales are a great resource. Moreover, the rationales help cement the recommendations for the busy practitioner: insight into the biologic plausibility and reasoning enable timely recall. The rationales also represent a foundation for educating healthcare practitioners on the recognition and treatment of sepsis. The deepest layer, the core of the onion, houses the evidentiary tables. The tables compile and organize the existing data in a manner that provides insight into the reasoning behind each recommendation (magnitude of benefit or harm and the quality of evidence). This layer is typically for the inquisitive clinician and for the clinical scientist with focused interest in sepsis.

A users’ guide to the 2016 Surviving Sepsis Guidelines