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Methods
The recommendations are graded based on a modified Delphi methodology with categorization as previously described (Table 1) [3]. The methods for this document build upon a 2001 publication Table 1 Grading system Grading recommendations

A. Supported by at least 2 level I investigations B. Supported by 1 level I investigation C. Supported by level II investigations only D. Supported by at least 1 level III investigation E. Supported by level IV or V evidence Grading of evidence I. Large, randomized trials with clearcut results; low risk of false-positive (alpha) error or false-negative (beta) error II. Small, randomized trials with uncertain results; moderate-tohigh risk of false-positive (alpha) and/or false-negative (beta) error III. Non-randomized, contemporaneous controls IV. Non-randomized, historical controls and expert opinion V. Case series, uncontrolled studies, and expert opinion sponsored by the International Sepsis Forum, and use the same method of recommendation grading [4]. The grading system was applied to the question from which each recommendation is created. The supplement submission includes background material, questions, and expanded rationale. This executive summary is targeted to be concise and user friendly for the bedside clinician.

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