Sepsis & septic shock · Protocolised early resuscitation
Early goal-directed therapy in the treatment of severe sepsis and septic shock
| Design | Single-centre randomised controlled trial |
|---|---|
| Treatment | Early goal-directed therapy protocol targeting central venous pressure, mean arterial pressure and central venous oxygen saturation |
| Control | Standard therapy |
| Population | 263 patients presenting to the emergency department with severe sepsis or septic shock |
| Follow-up | 60 days |
| Primary endpoint | In-hospital mortality |
| Result | In-hospital mortality was substantially lower with early goal-directed therapy than with standard therapy, with no significant differences in baseline characteristics between the 130 and 133 patients in each arm. |
| Secondary endpoints | Organ dysfunction scores, lactate clearance, resource use |
Early goal-directed therapy provides significant benefits with respect to outcome in patients with severe sepsis and septic shock.
The trial authors, in the published abstract
Reshaped sepsis care worldwide on the strength of 263 patients at one centre, then failed to replicate three times over in ProCESS, ARISE and ProMISe. The most likely explanation is that usual care caught up: early recognition, prompt antibiotics and fluids became standard because of this trial, leaving nothing for the protocol to add.
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001 Nov 8;345(19):1368-77.