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As regular PulmCCM readers know, the ProCESS, ARISE and ProMISe randomized trials showed no benefit of protocolized early goal-directed therapy as compared to usual conscientious care in the treatment of severe sepsis and septic shock.
In response to ProCESS and ARISE, the influential Surviving Sepsis Campaign now advises that measurement of central venous pressure (CVP) and central venous oxygenation (ScVO2) -- two core components of the so-called EGDT sepsis bundle -- are not necessary for all patients with septic shock.
As long as patients have received timely antibiotics and fluid resuscitation, the Campaign says, "requiring measurement of CVP and ScvO2 in all patients ... is not supported by the available evidence."
They further reported that the Surviving Sepsis committee would "immediately review the evidence" to determine whether and when an update is needed to its practice-defining Surviving Sepsis Guidelines.
After the publication of ProMISe, it looks like that revision is coming soon. The Surviving Sepsis website now says:
As the results of PROMISE are in line with the results of the ProCESS and ARISE studies, the hemodynamic bundle will be revised soon. This re-evaluation by the Surviving Sepsis Campaign is currently underway.
Their statement also emphasizes that as there was no adverse effect from using the existing published sepsis bundles, there is no harm in continuing them until guidelines are revised.
(No harm, unless you count the wasted time, attention, expense, and unneeded placement of central venous catheters. -PulmCCM Editors)
Surviving Sepsis Campaign Statement Regarding Hemodynamic and Oximetric Monitoring in Response to ProCESS and ARISE Trials. October 1, 2014 (but PulmCCM is just now finding out about it. Surviving Sepsis is not on twitter yet.)