ICU SAQs · Resuscitation
Early goal-directed therapy and its refiners — ProCESS and ARISE
A CICM Second-Part critical-appraisal SAQ on the EGDT era — the Rivers trial (NEJM 2001) mortality reduction, the ProCESS and ARISE trials showing EGDT no longer superior to usual care, and the synthesis that early recognition + antibiotics + fluid/vasopressor (not the rigid protocol) is what matters.
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Prompt
Critically appraise the role of early goal-directed therapy (EGDT) in the resuscitation of septic shock. What did the original trial show, how did the later trials refine it, and what is the current practice?
Question
Critically appraise the role of early goal-directed therapy (EGDT) in the resuscitation of septic shock. What did the original trial show, how did the later trials refine it, and what is the current practice?
[1]References4ShowHide
- [1]Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine, 2001.PMID 11794169
- [2]Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock (ProCESS). New England Journal of Medicine, 2014.PMID 24635773
- [3]Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock (ARISE). New England Journal of Medicine, 2014.PMID 25272316
- [4]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.