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

被引：0
作者：
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
机构：
[1] Loma Linda University,Department of Medicine, Pulmonary and Critical Care Medicine
[2] Loma Linda University,Department of Emergency Medicine
[3] Wayne State University,Department of Emergency Medicine, Henry Ford Hospital
[4] Mayo Clinic Rochester,Division of Pulmonary and Critical Care Medicine
[5] Vanderbilt University,Department of Medicine, Pulmonary and Critical Care Medicine
[6] Wayne State University,Department of Medicine, Pulmonary and Critical Care Medicine, Henry Ford Hospital
[7] University of Kentucky,Department of Medicine, Pulmonary and Critical Care Medicine
[8] Mercy Hospital Medical Center,Department of Internal Medicine
[9] University of Texas Health Science Center at Houston,Department of Internal Medicine, Division of Critical Care Medicine
[10] Wayne State University,Department of Internal Medicine, Henry Ford Hospital
[11] Universidad Peruana Cayetano Heredia,CONEVID, Conocimiento y Evidencia Research Unit
[12] Harvard Medical School,Department of Emergency Medicine, Massachusetts General Hospital
[13] Pulmonary and Critical Care Medicine,Pulmonary and Critical Care Medicine
[14] California Pacific Medical Center,Department of Emergency Medicine
[15] University of Kansas,Department of Surgery, Division of Surgical Critical Care
[16] Orlando Regional Medical Center,Department of Surgery, Henry Ford Hospital
[17] University of Central Florida College of Medicine,Department of Quality Assurance
[18] University of Florida College of Medicine,undefined
[19] University of South Florida College of Medicine,undefined
[20] Florida State University College of Medicine,undefined
[21] Icahn School of Medicine,undefined
[22] Mount Sinai Hospital,undefined
[23] ,undefined
[24] Wayne State University,undefined
[25] Aspirus Hospital,undefined
来源：
Critical Care | / 20卷
关键词：
Septic Shock; Systemic Inflammatory Response Syndrome; Intensive Care Unit Admission; Central Venous Pressure; Survive Sepsis Campaign;
D O I：
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学科分类号：
摘要：
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.
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