CanadiEM MVP Infographic Series – Protocol-Based Care for Early Septic Shock

In Infographics, Medical Concepts by Anson DinhLeave a Comment

In this issue of the MVP Infographic Series, we feature: “A randomized trial of protocol-based care for early septic shock” published by the ProCESS Investigators.1

There are more than 750 000 cases of sepsis each year that occur in the United States annually.  Rates of associated mortality were high, but a huge break through to lowering morality rates shook the world of emergency medicine in 2001.  Rivers et al. presented early goal-directed therapy (EGDT) for severe sepsis and septic shock, which demonstrated a decrease of morality rates from 46.5% to 30.5%.2  Fast forward a decade and EGDT is still in use in various forms, but practice has changed drastically since this study.  The ProCESS Investigators take a look at the EGDT protocol and compare it to modern protocols to study how they compare in the current day.

The methods and results of the paper are highlighted above.  Limitations of the study included: patients enrolled were different than the original EGDT study, patients with delayed diagnosis of septic shock were not included, and a limited ability to analyze subgroup benefits.1  In conclusion, ProCESS investigators were able to demonstrate no difference in 60, 90, and 365 day mortality between all three protocols; reflecting the great strides that early septic shock care has come in the past decade!


The P. A Randomized Trial of Protocol-Based Care for Early Septic Shock. N Engl J Med. 2014;370(18):1683-1693. [PMC]
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377. [PubMed]

Anson Dinh

Anson Dinh is a medical student at the University of Saskatchewan, Class of 2021. His academic interests involve ultrasound and simulations. His hobbies include bouldering, journaling, and collecting fountain pens.
Alvin is currently a PGY5 in the FRCP EM program at McMaster University. He serves as Director of Design for CanadiEM and has interests in knowledge translation and health innovation.