Podcast 134 – ARISE has arisen; now where do we stand on Severe Sepsis in 2014 - a podcast by Scott D. Weingart, MD FCCM

So the Arise Study (Australasian Resuscitation In Sepsis Evaluation) just dropped. The amazing guys at the Bottom Line did a summary (saving me a bunch of work)

Sorry, you do not have iframe working. Click here to go to the article.

Baseline Characteristics



Table S5-Therapies in the first 6 hours and 3 days



Videos from a Prime Author

Hear from Sandra Peake

Recognition-Find em' Early

SIRS+



Lactate or Persistent Hypotension (Arise used 1 liter)



I would use STOP Sepsis Campaign Modification of SIRS Critieria, so you don't need to wait for cbc





Treatment-Treat the Source/Perfuse the Tissues



Antibiotics

Another trial showing early abx are associated with goodness



If a patient is sick and you don't know what is going on, just give them appropriate spectrum abx. If a patient is persistently hypotensive and you don't know why--give them abx.



A very cute antibiotic summary

Source Control

Early, early, early

Don't box 'em with the tube

See the Hemodynamic Kills Lecture

The Right Amount of Fluid

Use whatever method you want, but you should probably give between 3-4 liters

Early Vasopressors

Give them peripherally to get them in fast and then you should probably put in a line



If you have given 3-4 liters, the patient probably deserves pressors for venous squeeze before giving more fluid

Check Your Work

Serial lactates?

Put them in a Monitored Setting

b/c of the way septic patients die

Other Stuff

Blood

No role for blood, except in niche cases, until Hb < 7 from the recent TRISS Trial (PMID 25270275)



Fewer pts got blood in EGDT group of either ProCESS or ARISE than the original EGDT study

Dobutamine

who the hell knows

Want to Hear from the Primary Investigator?

Oli Flower did a podcast in which Anthony Delaney addresses many comments from this post. Here's Oli:



Thanks Scott for your insights on ARISE and the state of play of sepsis management in 2014.



These open discussions that your podcast stimulates are incredibly important and essential for translating research findings into practice, and getting the important messages and critical interpretation of the data to as many people as possible!



Yesterday I interviewed the ARISE PI Anthony Delaney to hear his take, now he’s allowed to finally talk about the results, and I went through a lot of your listener’s comments to get an answer from the horse’s mouth.



The interview is here:

http://intensivecarenetwork.com/delaney-arise-study-emcrit-dogmalysis/



Cheers,

Oli



What do you think?

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM