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01-12-2015 | Review

Early goal-directed resuscitation of patients with septic shock: current evidence and future directions

Authors: Ravi G. Gupta, Sarah M. Hartigan, Markos G. Kashiouris, Curtis N. Sessler, Gonzalo M. L. Bearman

Published in: Critical Care | Issue 1/2015

Abstract

Severe sepsis and septic shock are among the leading causes of mortality in the intensive care unit. Over a decade ago, early goal-directed therapy (EGDT) emerged as a novel approach for reducing sepsis mortality and was incorporated into guidelines published by the international Surviving Sepsis Campaign. In addition to requiring early detection of sepsis and prompt initiation of antibiotics, the EGDT protocol requires invasive patient monitoring to guide resuscitation with intravenous fluids, vasopressors, red cell transfusions, and inotropes. The effect of these measures on patient outcomes, however, remains controversial. Recently, three large randomized trials were undertaken to re-examine the effect of EGDT on morbidity and mortality: the ProCESS trial in the United States, the ARISE trial in Australia and New Zealand, and the ProMISe trial in England. These trials showed that EGDT did not significantly decrease mortality in patients with septic shock compared with usual care. In particular, whereas early administration of antibiotics appeared to increase survival, tailoring resuscitation to static measurements of central venous pressure and central venous oxygen saturation did not confer survival benefit to most patients. In the following review, we examine these findings as well as other evidence from recent randomized trials of goal-directed resuscitation. We also discuss future areas of research and emerging paradigms in sepsis trials.

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Title: Early goal-directed resuscitation of patients with septic shock: current evidence and future directions
Authors: Ravi G. Gupta
Sarah M. Hartigan
Markos G. Kashiouris
Curtis N. Sessler
Gonzalo M. L. Bearman
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-015-1011-9

At a glance: The STEP trials

Springer Medicine

Early goal-directed resuscitation of patients with septic shock: current evidence and future directions

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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