Tuesday, 26 May 2015

Trial of early, goal-directed resuscitation for septic shock. NJEM April 2015.

Since 2002 the Surviving Sepsis Campaign has promoted best practice for the management of sepsis, including early recognition, source control, appropriate and timely antibiotic administration and resuscitation with intravenous fluids and vasoactive drugs. These recommendations are mainly based on a single centre landmark study by Rivers et al in 2001.

This randomised trial compared early, goal-directed therapy (EGDT, a 6 hour protocol) or usual care in 1260 patients with septic shock across 56 hospitals in England. There was no significant different in the primary outcome of mortality at 90 days among those receiving 6 hours of EGDT and those receiving usual resuscitation. Treatment intensity was greater in the EGDT group, including increased use of central venous catheters, intravenous fluids, vasoactive drugs and red-cell transfusion. This group also has significantly worse organ-failure scores and spent more days in ICU. There were no significant differences in any secondary outcomes including health-related quality of life or rates of serious adverse events. The use of EGDT also increased costs. This finding may be attributed to the short intervention phase of 6 hours or that techniques used in usual resuscitation have significantly improved over the last 15 years.

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