Early Antibiotics and Fluids Are More Important than Strict Protocol Adherence in the Treatment of Sepsis

Mortality was similar among patients in septic shock who were randomized to early goal-directed therapy, less invasive but protocolized standard care, or provider-directed usual care.

A landmark 2001 study demonstrated that early and aggressive treatment of patients with sepsis improved their outcomes (NEJM JW Infect Dis Dec 21 2001). However, the early goal-directed therapy (EGDT) bundle used in that study required invasive central venous pressure and central venous oxygen saturation monitoring, in addition to other treatments. To determine which aspects of EGDT are truly necessary, investigators in the NIH-funded ProCESS study randomized patients with septic shock at 31 U.S. emergency departments to one of three groups: EGDT, a less invasive 6-hour protocol involving peripheral access and slightly different hemodynamic goals, or provider-directed usual care.

The primary endpoint of 60-day mortality did not differ signif…

Reviewing Author

Ali S. Raja, MD, MBA, MPH, FACEP

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Board Member); American College of Healthcare Executives – Massachusetts (Board Member)

Ali S. Raja, MD, MBA, MPH, FACEP

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Board Member); American College of Healthcare Executives – Massachusetts (Board Member)

Early Antibiotics and Fluids Are More Important than Strict Protocol Adherence in the Treatment of Sepsis

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Reviewing Author