Sepsis is a significant cause of mortality, and improving survival has gained a lot of attention over the last 2 decades as a measure for quality improvement. Mortality rates from sepsis as high as 49.7%¹ were the stimulus for Rivers et al² to develop early goal-directed therapy in 2001, resulting in significantly lower mortality rates (30.5%). In 2002, the Surviving Sepsis Campaign, an international effort led by intensivists, began promoting early recognition and treatment of sepsis. This campaign ultimately led to the adoption of Early Management Bundle for Severe Sepsis/Septic Shock (SEP-1) by the US Centers for Medicare & Medicaid Services (CMS) in October 2015. At almost the same time, 3 randomized clinical trials of early goal-directed therapy vs usual care were published. The Protocolised Care for Early Septic Shock (ProCESS) trial,³ Australasian Resuscitation in Sepsis Evaluation (ARISE) trial,⁴ and Protocolised Management in Sepsis (ProMISe) trial⁵ found no survival benefit in patients with sepsis between early goal-directed therapy and usual care. The final version of the SEP-1 bundle adopted by CMS removed the invasive monitoring requirement from early goal-directed therapy and adopted the fluid volume and the repeated lactate metrics without significant evidenced-based support.

败血症是导致死亡的重要原因，在过去的20年中，改善生存率已成为引起人们关注的质量改进措施。败血症死亡率高达49.7％¹是Rivers等人的刺激因素²在2001年开发了早期的目标导向疗法，从而大大降低了死亡率（30.5％）。在2002年，由强化医生领导的国际努力的“幸存脓毒症运动”开始促进败血症的早期识别和治疗。这项运动最终导致美国医疗保险和医疗补助服务中心（CMS）在2015年10月采用了严重脓毒症/败血性休克早期治疗套装（SEP-1）。几乎同时，有3项早期随机临床试验目标导向疗法与常规护理的比较已经发表。协议处理的早期脓毒症休克（ProCESS）试验，³脓毒症评估中的澳大利亚复苏（ARISE）试验，⁴和脓毒症的协议化管理（ProMISe）试验⁵发现脓毒症患者在早期目标导向治疗和常规治疗之间没有生存获益。CMS采用的最终版本的SEP-1束消除了早期目标导向疗法的侵入性监测要求，并采用了液体量和重复的乳酸指标，而没有明显的循证医学支持。