Three trials in the past 18 months that have challenged early goal-directed therapy for patients with sepsis have some emergency physicians wondering what to do.

The answer from Nathan Shapiro, MD, MPH: attend his Wednesday session dubbed “Get the BP Up! The Who, When, and Why of Today’s Sepsis Fluid Therapy.”

“Therefore, the idea of having your fluid therapy tied back to a central venous pressure only is no longer necessarily an evidenced-based improvement in mortality.” —Dr. Shapiro

“It leaves us with a dilemma in the sense that we have now have a trial showing that an average of roughly four liters of fluid and good clinical judgment to adjust volumes further [are] essentially what we need, but we also know there are perils with fluid overload and not giving enough fluid,” said Dr. Shapiro, an attending physician in Beth Israel Deaconess Medical Center’s emergency department in Boston. “Going forward, we have to look for new ways to titrate our fluid therapy.”

Dr. Shapiro said the session will review the history of care for septic patients and, using a case-based discussion, will delve into some of the best practices based on the new trials, known as ARISE, ProCESS, and ProMISe.

“Three trials have come out showing that goal-directed therapy was not necessarily better than the usual care being followed by clinicians in the current era,” he said. “Therefore, the idea of having your fluid therapy tied back to a central venous pressure only is no longer necessarily an evidenced-based improvement in mortality.”