Journal Club

Question 1

What were the physiologic goals/parameters in the Rivers 2001 Early goal directed study? (4)

Answer 1

1. CVP 8-12mmHg, achieved with fluid boluses
   (CVP was measured CONTINUOUSLY for first 6 hours and assessed q 12)
2. MAP >65mmHg, achieved with vasopressors if necessary
3. ScvO2 >70%, achieved with packed RBC transfusions and dobutamine if necessary
4. UOP >0.5mL/kg/hr

Question 2

What was the primary result in the Rivers et. al 2001 EGDT trial?

Answer 2

With the use of EGDT bundle there was a significant reduction of mortality 46.5% in standard group vs. 30.5 60 day mortality in EGDT. Thats a 16% mortality reduction.
NNT = 6

Question 3

What did the ProCESS trial show? 2014

Answer 3

That there was no mortality difference between the EGDT vs. protocol vs ‘usual’ (non protocolized) care. Mortality was approximately 20%

Question 4

What did the Kumar et. al 2010 Critical care study show?

Answer 4

Combination antibiotic therapy improves survival and clinical response of high-risk, life-threatening infections, particularly those associated with septic shock. But it may be detrimental in low risk patients.

Question 5

From the ProCESS trial what is the take home point?

Answer 5

This is whats important:

1. Early recognition of severe sepsis, and septic shock
2. Early Administration of Fluids
3. Early Administration of Antibiotics

Question 6

What did the TRICC (transfusion requirements in critical care) trial show?

Answer 6

Multi-centre RCT. ICU. NEJM 1999

Among critically ill patients, a restrictive transfusion strategy (hemoglobin goal of 7-9 g/dL) was associated with improved survival compared with a liberal transfusion strategy (Hgb goal of 10-12 g/dL).