ARISE

Report
ARISE
Goal-Directed Resuscitation for Patients with Early Septic Shock
NEJM October 2014
Standard care vs EGDT
In septic shock
EGTD
CVC ; fluid boluses of 500ml aiming at 8/12mmHg
MAP, aim for 65-90 mmHg; vasopressors/vasoldilators as indicated
ScvO2 aim for > 70%
if Hct < 30% or HB < 10 g/dl given PRC
if still <70 % given dobutamine
and
and then if still <70% consider NIV/intubation with paralysis
sedation
STANDARD CARE
Decided by the treating team
PRIMARY OUTCOME
All cause mortality at 90 days, with multiple secondary outcomes
GROUPS
Approx 800 patients in each arm
Very similar baseline characteristics
OUTCOMES
No statistically significant difference in the 90 day mortality between the 2 groups
18.6% in EGDT
18.8% in usual therapy group
TAKE AWAY POINTS
Consistent findings with the ProCESS trial, no obvious benefit with EGDT vs standard care
Beware of the Hawthorne effect
Observed difficulty in antibiotic administration on 60 minutes
REFERENCES
ARISE paper
NEJM supplementart appendix
Surviving Sepsis Campaign
CEM; sepsis resource

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