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 65-90 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 CAREDecided by the treating team

PRIMARY OUTCOME

All cause mortality at 90 days, with multiple secondary outcomes

GROUPSApprox 800 patients in each arm

Very similar baseline characteristics

OUTCOMESNo 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

REFERENCESARISE paper

NEJM supplementart appendix

Surviving Sepsis Campaign

CEM; sepsis resource