Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis (PRISM)
PRISM Investigators, 2017 · 3 studies included
Summary
A prospectively planned, individual-patient-data meta-analysis pooling the three large multicenter trials (ProCESS, ARISE, ProMISe, 2014-2015) that re-tested the original 2001 Rivers protocolized early goal-directed therapy (EGDT) — central-line-guided, ScvO2/CVP-targeted resuscitation — against usual, unprotocolized early sepsis care.
Conclusion
Protocolized EGDT did not reduce mortality compared with usual care across the pooled trials, and was associated with a higher use of ICU resources. This ended the mandate for the specific 2001 Rivers protocol as a fixed algorithm; it did not overturn the underlying principles of early recognition, cultures, timely antibiotics, and fluid resuscitation that both the protocolized and usual-care arms of these trials still received.
Clinical Context & Relevant Topics (2)
Disease ReferenceLife-threatening organ dysfunction caused by a dysregulated host response to infection — recognized by an acute rise in SOFA score, not by infection plus fever alone.
The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.