1. Goal-Directed Resuscitation for Patients with Early Septic Shock NEJM October 2014 ARISE

2. Standard care vs EGDT In septic shock

3. EGTD CVC ; fluid boluses of 500ml aiming at 8/12mmHg MAP, aim for 65-90 mmHg; vasopressors/vasoldilators as indicated ScvO2 aim for > 70% if Hct < 30% or HB < 10 g/dl given PRC if still <70 % given dobutamine and then if still <70% consider NIV/intubation with paralysis and sedation

4. STANDARD CARE Decided by the treating team

5. PRIMARY OUTCOME All cause mortality at 90 days, with multiple secondary outcomes

6. GROUPS Approx 800 patients in each arm Very similar baseline characteristics

7. OUTCOMES No statistically significant difference in the 90 day mortality between the 2 groups 18.6% in EGDT 18.8% in usual therapy group

8. TAKE AWAY POINTS Consistent findings with the ProCESS trial, no obvious benefit with EGDT vs standard care Beware of the Hawthorne effect Observed difficulty in antibiotic administration on 60 minutes

9. REFERENCES ARISE paper NEJM supplementart appendix Surviving Sepsis Campaign CEM; sepsis resource