Twitter and the usual accelerated knowledge translation sites have been abuzz with the release of several important articles regarding resuscitation in severe sepsis.
The one garnering the most press is ProCESS, a 1:1:1 randomization of patients with severe sepsis into Early Goal-Directed Therapy, protocol-based aggressive fluid resuscitation, or “usual care”. Many detailed analyses and sub-analyses will likely be written, but, the basic gist – it appears the critical innovation coming out out of Rivers’ EGDT is awareness of the importance of any aggressive early recognition and treatment. The primary outcome – in-hospital mortality at 60-days – was similar across each group. And, the minor variations in secondary outcomes probably support simply paying close attention to individual patient physiology.
This is not specifically practice-changing in many critical care settings – there has been plenty of skepticism regarding the specific interventions in the Rivers’ algorithm. The search will certainly go on regarding ways to improve upon the 20% modern mortality in severe sepsis, but it is now easily defensible to eschew the Edwards’ catheter, blood transfusions, and dobutamine from Rivers’ specific protocol.
“A Randomized Trial of Protocol-Based Care for Early Septic Shock”
http://www.nejm.org/doi/full/10.1056/NEJMoa1401602