Protocol-Based Management of Severe Sepsis and Septic Shock

Abstract

Sepsis remains a significant public health problem, with increasing incidence but decreasing mortality worldwide. The landmark Rivers study published in 2001 revolutionized the management of sepsis and septic shock, and brought early recognition, early antibiotic therapy, and protocol-based care to the forefront of sepsis management. However, certain components of the Rivers protocol have remained controversial and have not been widely accepted into practice. In addition, data for elements not included in the Rivers protocol have emerged. A series of three trials (ProCESS, ARISE, and ProMISe) designed with harmonized methods have recently demonstrated a lack of survival benefit for patients with septic shock treated with early goal directed therapy compared with usual care. Based on the results of these studies, the surviving sepsis campaign and national quality forum are revising their recommendations related to sepsis management.