Goal-Directed Resuscitation for Patients with Early Septic Shock NEJM October 2014 ARISE.

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Presentation transcript:

Goal-Directed Resuscitation for Patients with Early Septic Shock NEJM October 2014 ARISE

Standard care vs EGDT In septic shock

EGTD CVC ; fluid boluses of 500ml aiming at 8/12mmHg MAP, aim for mmHg; vasopressors/vasoldilators as indicated ScvO2 aim for > 70% if Hct < 30% or HB < 10 g/dl given PRC if still <70 % given dobutamine and then if still <70% consider NIV/intubation with paralysis and sedation

STANDARD CARE Decided by the treating team

PRIMARY OUTCOME All cause mortality at 90 days, with multiple secondary outcomes

GROUPS Approx 800 patients in each arm Very similar baseline characteristics

OUTCOMES No statistically significant difference in the 90 day mortality between the 2 groups 18.6% in EGDT 18.8% in usual therapy group

TAKE AWAY POINTS Consistent findings with the ProCESS trial, no obvious benefit with EGDT vs standard care Beware of the Hawthorne effect Observed difficulty in antibiotic administration on 60 minutes

REFERENCES ARISE paper NEJM supplementart appendix Surviving Sepsis Campaign CEM; sepsis resource