As promised, the Australians have killed EGDT in Sepsis. Just to make sure some points aren’t lost here, the following is accepted as standard practice:1. there is no debate on the definition of sepsis as per Rivers 2. even in the control groups (called standard care here) antibiotics were given 3. The use of fluids and vasopressors were also used in standard care.
So what is this whole ARISE thing you are so excited about ? 1. This trial was huge 1600 patients 2. the EGDT group as per Rivers were more aggressive with fluids , packed cells and pressors (and by a lot when compared) 3. The EGDT group was allowed to use SCVO2 which was not allowed in the control group. 4. There was no significant difference in a. survival time b. in-hospital mortality c. 90 day mortality d. duration of organ support e. length of hospital stay.
At this juncture we already have 2 large RCT’s - ARISE and PROCESS both of which clearly show the regimented approach to treating sepsis as having no difference in outcomes.
However it is important to note that Rivers et al did a great service in highlighting the need to identify sepsis early and treat. What these 2 new trials show is that there might not be a benefit in being so aggressive in managing patients in sepsis in particular patients with septics shock .
Links: PROCESS - http://www.nejm.org/doi/pdf/10.1056/nejmoa1401602 ARISE - http://www.nejm.org/doi/pdf/10.1056/NEJMoa1404380 this is the link for rivers et al response to the PROCESS trial. http://www.survivingsepsis.org/…/SSC-Responds-Process-Trial…