In patients with severe sepsis in the Emergency Department dose protocol-based resuscitation improve outcomes
No mortality or morbidity benefit was found with protocol-based resuscitation compared to bedside care in patients with severe sepsis.
This multicenter randomized trial assigned patients 1341 patients to protocol EGDT (Early Goal Directed Therapy), protocol-based standard therapy that did not require the placement of a central venous catheter, administration of inotropes, or blood transfusions or usual care which was not standardized. The data was analyzed with intention to treat to determine in protocolized treatment of sepsis had a mortality benefit as was shown in the original Rivers Trial. No significant 60 or 90 day mortality benefit was found to the protocol therapy and greater hospital resources such as ICU admissions were found in the protocol based groups.
- Multicenter Randomized trial of 1241 patients (439 in protocol-based EGDT, 446 in protocol based standard therapy, and 456 in the usual-care group)
- The same physician led team implemented the EGDT and protocol based standard therapies
- The resuscitation guidelines were published in the supplemental document
- Emergency Department Patients with suspected sepsis
- ≥18 years old
- Two Systemic Inflammatory Response Syndrome criteria
- Refractory Hypotension OR
- Serum Lactate ≥ 4 mmol/L