UMEM Educational Pearls

Title: First PROCESS, now ARISE and resuscitate your septic patients

Posted: 10/6/2014 by John Greenwood, MD (Emailed: 10/7/2014) (Updated: 10/7/2014)
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The ARISE Trial

Early, aggressive resuscitation and attention to detail are essential element of managing critically ill patients. This past week the ARISE trial was published - a 2nd large, randomized control study to examine the benefit of protocolized vs. usual care in patients with severe sepsis and septic shock.

What were the main findings? After enrolling 1,600 patients who presented to the ED in severe sepsis or septic shock:

They found no difference in mortality between the control (usual care) and treatment arm (early goal-directed therapy)
Mortality was 18.6% vs. 18.8% at 90 days
No evidence that continuous ScVO2, Hgb target > 10 mg/dL (check out the TRISS trial), or use of inotropes with a normal cardiac index improved mortality

Bottom Line: Resuscitation goals for the patient with septic shock should include:

Early antibiotics (source control)
Adequate volume resuscitation (preferably balanced, crystalloid solution)
End-organ perfusion (lactate normalization)

Additional therapeutic goals should be made on a patient by patient basis. Reassess your patient frequently, pay attention to the details, and you will improve your patient’s mortality.

Suggested Reading

The ARISE Investigators and the ANZICS Clinical Trials Group. Goal-Directed Resuscitation for Patients with Early Septic Shock. N Engl J Med. 2014. [PubMed Link]
Wessex ICS: The Bottom Line Review

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