The rage for treating sepsis has been the Early Goal Directed Therapy. It is promoted by the "Surviving Sepsis" campaign. There are these 3 hour and 6 hour bundles. A central venous catheter needs to be placed. Measure CVP, CVO2 sat, mixed venous O2 sat, repeat lactic acid every 6 hours, give blood and dobutamine based on these parameters. This was all based on a single medical center trial with 260 or so patients and showed EGDT had a mortality of 30% and no EGDT had a mortality of 45%. At the time, everyone ran with it thinking EGDT was where it is at.
Then the proCESS trial came out. This was a multi center trial with 1360 patients, each divided into three groups: EGDT, therapy based on MAP and urine output, and usual care. No difference in mortality, LOS, organ failure.
So why is it that so many are still embracing a small trial from 2001 as opposed to the proCESS trial? Hospitals still are keeping close tabs on core measures with sepsis based on this 2001 trial with EGDT when a recent, large, multi center trial has shown that EGDT shows no mortality benefit over no EGDT.
Essentially what saves people's lives is giving lots of fluids early, if it doesn't work then pressors, and give broad spectrum antibiotics early. All the other fluff like lactic acid, CV O2 sat, mixed venous O2 sat, CVP all looks cute and fancy, but it is not saving lives.
Hospitals and physicians are now getting dinged if they don't meet these core sepsis measures, despite a major trial debunking their value.
Then the proCESS trial came out. This was a multi center trial with 1360 patients, each divided into three groups: EGDT, therapy based on MAP and urine output, and usual care. No difference in mortality, LOS, organ failure.
So why is it that so many are still embracing a small trial from 2001 as opposed to the proCESS trial? Hospitals still are keeping close tabs on core measures with sepsis based on this 2001 trial with EGDT when a recent, large, multi center trial has shown that EGDT shows no mortality benefit over no EGDT.
Essentially what saves people's lives is giving lots of fluids early, if it doesn't work then pressors, and give broad spectrum antibiotics early. All the other fluff like lactic acid, CV O2 sat, mixed venous O2 sat, CVP all looks cute and fancy, but it is not saving lives.
Hospitals and physicians are now getting dinged if they don't meet these core sepsis measures, despite a major trial debunking their value.