Difference between revisions of "EBQ:ProMISe Trial"
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Revision as of 16:59, 8 May 2015
incomplete Journal Club Article
Mouncey PR, Osborn TM, Power GS, et al. "Trial of Early, Goal-Directed Resuscitation for Septic Shock". NEJM. 2015. 14(372):1301-1311.
PubMed Full text
PubMed Full text
Contents
Clinical Question
Is there a different between EGDT versus “usual care” in 90-day mortality?
Conclusion
Using EGDT did not lead to an improved outcome
Major Points
Study Design
Population
56 hospitals in the UK
Patient Demographics
Inclusion Criteria
- ≥18 years of age
- Within 6 hours of presenting to ED
- Known or presumed infection
- 2 or more SIRS criteria
- Refractory hypotension (<90 SBP or <65 MAP after 1L IVF trial) or hyperlactatemia (≥4.0)
Exclusion Criteria
- CVA
- ACS
- Cardiac dysrhythmia
- Acute pulmonary edema
- GI bleed
- Seizure
- Drug overdose
- Burn or trauma
- Immediate surgery needed
- CD4 count <50
- Advance directive that restricts either protocol
- Contraindication to interventions including refusal of blood transfusions
- Pregnant
- Transfer patient
Interventions
- Radomization within 2 hours after meeting criteria
Group 1 – EGDT (n=623)
- Airway/breathing
- Central line with oximetric port
- Sedation, analgesia, and/or paralysis
- IVF per CVP
- Vasoactive agents per MAPs
- Transfusion and inotrope agents per ScvO2
- Reassess
Group 2 – Usual Care (n=620)
- Airway/Breathing
- 2 large bore IVs (or central line if not achieved)
- Sedation, analgesia, and/or paralysis
- Resuscitate with 2L IVF
- IVF and vasopressors per MAPs
- Reassess