Division of Emergency Medicine, Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359702, Seattle, WA 98104, USA.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, W-CC2, Boston, MA 02215, USA.
Clin Chest Med. 2016 Jun;37(2):231-9. doi: 10.1016/j.ccm.2016.01.016. Epub 2016 Mar 7.
The Early Goal-Directed Therapy versus Standard Care for Sepsis trial by Rivers and colleagues in 2001 suggested that a significant mortality reduction may be realized through goal-directed interventions early in the care of patients with septic shock. However, the recent publication of the Protocol-Based Care for Early Septic Shock (ProCESS), Australasian Resuscitation in Sepsis Evaluation (ARISE), and Protocolised Management in Sepsis (ProMISE) trials did not demonstrate the superiority of early goal-directed therapy over usual care. If usual care includes timely and meticulous care, a protocol may not be needed to realize the continued lowering mortality rates.
2001 年，里弗斯（Rivers）等人开展的早期目标导向治疗与常规治疗对脓毒症的试验表明，通过在脓毒性休克患者的治疗早期进行目标导向干预，可能显著降低死亡率。然而，最近发表的基于方案的早期脓毒性休克治疗（ProCESS）、澳大利亚脓毒症复苏评估（ARISE）和脓毒症方案管理（ProMISE）试验并未证明早期目标导向治疗优于常规治疗。如果常规治疗包括及时和细致的护理，那么可能不需要方案即可实现持续降低死亡率。
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