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Early goal-directed therapy in severe sepsis and septic shock

Title: Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE.
Name(s): Nguyen, H Bryant, author
Jaehne, Anja Kathrin, author
Jayaprakash, Namita, author
Semler, Matthew W, author
Hegab, Sara, author
Yataco, Angel Coz, author
Tatem, Geneva, author
Salem, Dhafer, author
Moore, Steven, author
Boka, Kamran, author
Gill, Jasreen Kaur, author
Gardner-Gray, Jayna, author
Pflaum, Jacqueline, author
Domecq, Juan Pablo, author
Hurst, Gina, author
Belsky, Justin B, author
Fowkes, Raymond, author
Elkin, Ronald B, author
Simpson, Steven Q, author
Falk, Jay L, author
Singer, Daniel J, author
Rivers, Emanuel P, author
Type of Resource: text
Genre: Journal Article
Date Issued: 2016-07-01
Physical Form: computer
online resource
Extent: 1 online resource
Language(s): English
Abstract/Description: 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.
Identifier: FSU_pmch_27364620 (IID), 10.1186/s13054-016-1288-3 (DOI), PMC4929762 (PMCID), 27364620 (RID), 27364620 (EID), 10.1186/s13054-016-1288-3 (PII)
Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at
Subject(s): Hemodynamics/physiology
Patient Care Planning
Shock, Septic/mortality
Shock, Septic/physiopathology
Shock, Septic/therapy
Persistent Link to This Record:
Host Institution: FSU
Is Part Of: Critical care (London, England).
Issue: iss. 1, vol. 20

Choose the citation style.
Nguyen, H. B., Jaehne, A. K., Jayaprakash, N., Semler, M. W., Hegab, S., Yataco, A. C., … Rivers, E. P. (2016). Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE. Critical Care (London, England). Retrieved from