Among patients with severe sepsis or septic shock, what is the efficacy of early goal-directed therapy EGDT in decreasing the risk of mortality? Among patients with severe sepsis or septic shock, early goal-directed therapy decreases the risk of mortality. The Rivers trial randomized patients with severe sepsis or septic shock at a single urban Detroit ED to a protocol of early goal-directed therapy EGDT vs. In the EGDT arm, patients received an arterial line and a central line with continuous central venous oxygen saturation ScvO 2 monitoring. While there was no difference in the total volume of administered fluid or percentage of patients receiving dobutamine at 72 hours, patients in the EGDT received more of both therapies in the first 6 hours.
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Background: Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The purpose of this study was to evaluate the efficacy of early goal-directed therapy before admission to the intensive care unit.
Methods: We randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy as a control before admission to the intensive care unit. Clinicians who subsequently assumed the care of the patients were blinded to the treatment assignment.
In-hospital mortality the primary efficacy outcome , end points with respect to resuscitation, and Acute Physiology and Chronic Health Evaluation APACHE II scores were obtained serially for 72 hours and compared between the study groups.
Results: Of the enrolled patients, were randomly assigned to early goal-directed therapy and to standard therapy; there were no significant differences between the groups with respect to base-line characteristics.
In-hospital mortality was During the same period, mean APACHE II scores were significantly lower, indicating less severe organ dysfunction, in the patients assigned to early goal-directed therapy than in those assigned to standard therapy Conclusions: Early goal-directed therapy provides significant benefits with respect to outcome in patients with severe sepsis and septic shock.
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Natanson C, Danner RL. Natanson C, et al. ACP J Club. Management of sepsis. Perel A, Segal E. Perel A, et al. Association between fluid balance and mortality in patients with septic shock: a post hoc analysis of the TRISS trial. Cronhjort M, et al. Acta Anaesthesiol Scand. Epub Mar PMID: In support of 'usual' perioperative care. Raghunathan K, Wang XS. Raghunathan K, et al. Br J Anaesth. Epub May No abstract available. Henning DJ, et al. Clin Chest Med. Epub Mar 7. PMID: Review.
Morton Hamer MJ, et al. Ann Emerg Med. Epub Jul Similar articles Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. Jones AE, et al. Clinical Trial.
Nguyen HB, et al. J Crit Care. Epub Oct Implementing a collaborative protocol in a sepsis intervention program: lessons learned. Casserly B, et al. Epub Nov Early goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature. Rivers EP, et al. Curr Opin Anaesthesiol. Crit Care. Show more similar articles See all similar articles. Cited by 2, articles Use, timing and factors associated with tracheal intubation in septic shock: a prospective multicentric observational study.
Darreau C, et al. Version 2. Ann Intensive Care. Breuer RK, et al. Pediatr Qual Saf. Fluid overload in patients with septic shock and lactate clearance as a therapeutic goal: a retrospective cohort study. Espinosa-Almanza CJ, et al. Rev Bras Ter Intensiva. Epub May 8. Sepsis-Induced Cardiomyopathy: a Comprehensive Review. L'Heureux M, et al.
Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock