Protocol-Based Care for Septic Shock

Abstract This chapter discusses the ProCESS trial, which evaluates whether invasive, monitoring-based, protocol-driven care for septic shock improves outcomes compared to less invasive care or usual care. The ProCESS trial recruited 1351 patients and compared three treatment arms: early goal-directed therapy with invasive monitoring, protocol-based standard therapy without invasive monitoring, and usual care. The trial found no significant difference in 60-day in-hospital mortality among the groups, though secondary outcomes reveal differences in organ failure and vasopressor use. The chapter highlights the potential disadvantages of invasive monitoring, suggesting that routine use of central venous or Swan-Ganz catheters may not be necessary in all cases. Finally, the chapter concludes that modern, individualized care, focusing on timely resuscitation and patient evaluation, is effective in managing septic shock.