Major sepsis study confirms back to basics approach

Abstract

In 2001 Rivers et al. published a landmark study in the New England Journal of Medicine showing that in a single centre, involving patients presenting to an emergency department with severe sepsis and septic shock, an early goal-directed therapy (EGDT) protocol significantly reduced mortality compared with those receiving usual care.¹ This underpinned the long-standing tenet of medical practice that early detection and treatment of sepsis will reduce mortality.

The recent ProCESS US randomised multi-centre study² had the aim of determining whether the Rivers et al. findings were generalisable and whether all aspects of the protocol in relation to EGDT were necessary. The study identified some key findings: There was no difference in mortality (in-hospital mortality to 60 days, 90 day or one-year mortality) between the three arms. This may suggest a negative trial. However, overall mortality was significantly lower than reported in the Rivers study in 2001, although the ProCESS study also included very sick patients.

Levels of adherence in relation to early recognition and early antibiotic treatment were high and on a par with what one would realistically expect to achieve in real global practice. Therefore, ProCESS is a refining trial showing that early recognition and resuscitation are key beneficial interventions.