Since the landmark 2001 trial by Rivers et al, early goal-directed therapy (EGDT) for septic shock has been endorsed as the standard of care. The multicenter Australasian Resuscitation in Sepsis Evaluation (ARISE) trial was designed to test the hypothesis that EGDT, as compared with usual care, would reduce all-cause mortality at 90 days among patients presenting to the emergency department with early septic shock. The study was a prospective, randomized, parallel-group trial hosted in 51 tertiary care and nontertiary care hospitals in Australia, New Zealand, Finland, Hong Kong, and Ireland.
The authors concluded that EGDT does not offer a survival advantage in patients presenting to the emergency department with early septic shock. This work represents the second published study in a triad of trials. The Protocolised Management in Sepsis (ProMISe) trial has yet to be published; the results of the Protocolized Care for Early Septic Shock (ProCESS) trial were published earlier this year. Strengths of the ARISE trial include an appropriate sample size, the multicenter nature of the study and high compliance with the intervention. However, early resuscitation and antibiotic administration likely are now regarded as “usual care,” and this may have had a significant impact before randomization. A meta-analysis of all three trials is planned when the ProMISe trial is completed. This meta-analysis — which could have greater power than any individual study — may demonstrate benefits of EGDT in certain patient populations.
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The Surviving Sepsis Campaign recently released an updated statement regarding hemodynamic and oximetric monitoring. This statement is in response to the ProCESS and ARISE trials. The statement highlights recently released data from the Surviving Sepsis Campaign, which confirms that “adherence to quality improvement measures in severe sepsis and septic shock is associated with mortality decline.”