Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE
Year: 2016
Type: review
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.
Source: Critical Care
Authors: H. Bryant Nguyen, Anja Kathrin Jaehne, Namita Jayaprakash, Matthew W. Semler, Sara Hegab, Angel Coz Yataco, Geneva Tatem, Dhafer Salem, Steven Moore, Kamran Boka, Jasreen Kaur Gill, Jayna Gardner-Gray, Jacqueline Pflaum, Juan Pablo Domecq, Gina Hurst, Justin B. Belsky, Raymond Fowkes, Ronald B. Elkin, Steven Q. Simpson, Jay L. Falk, Daniel J. Singer, Emanuel P. Rivers
Institutions: Loma Linda University, Wayne State University, Henry Ford Hospital, Mayo Clinic, Vanderbilt University, University of Kentucky, Mercy Hospital and Medical Center, The University of Texas Health Science Center at Houston, Universidad Peruana Cayetano Heredia, Harvard University, Massachusetts General Hospital, California Pacific Medical Center, University of Kansas, Florida State University, University of Central Florida, University of South Florida, Orlando Regional Medical Center, University of Florida, Mount Sinai Health System, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,190
OpenAlex ID: W2398023930