Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE.

Authors

H B. Nguyen
Anja K. Jaehne, Henry Ford HealthFollow
Namita Jayaprakash
Matthew W. Semler
Sara Hegab, Henry Ford HealthFollow
Angel C. Yataco
Geneva Tatem, Henry Ford HealthFollow
Dhafer Salem
Steven Moore, Henry Ford Health
Kamran Boka
Jasreen Gill, Henry Ford HealthFollow
Jayna Gardner-Gray, Henry Ford HealthFollow
Jacqueline Pflaum, Henry Ford HealthFollow
Juan P. Domecq, Henry Ford Health
Gina Hurst, Henry Ford HealthFollow
Justin B. Belsky
Raymond Fowkes, Henry Ford HealthFollow
Ronald B. Elkin
Steven Q. Simpson
Jay L. Falk
Daniel J. Singer
Emanuel Rivers, Henry Ford HealthFollow

Recommended Citation

Nguyen HB, Jaehne AK, Jayaprakash N, Semler MW, Hegab S, Yataco AC, Tatem G, Salem D, Moore S, Boka K, Gill JK, Gardner-Gray J, Pflaum J, Domecq JP, Hurst G, Belsky JB, Fowkes R, Elkin RB, Simpson SQ, Falk JL, Singer DJ, and Rivers EP. Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE. Crit Care 2016; 20(1):160.

Document Type

Article

Publication Date

7-1-2016

Publication Title

Critical care (London, England)

Abstract

Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients. As a result, early goal-directed therapy was largely incorporated into the first 6 hours of sepsis management (resuscitation bundle) adopted by the Surviving Sepsis Campaign and disseminated internationally as the standard of care for early sepsis management. Recently a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate interpretation of these trials and their conclusions.

Medical Subject Headings

Hemodynamics; Humans; Patient Care Planning; Resuscitation; Sepsis; Shock, Septic

PubMed ID

27364620

Volume

20

Issue

1

First Page

160

Last Page

160