"Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock". The New England Journal of Medicine. 2001. 345(19):1368-1377. PubMed
Links to original sources: Wiki Journal Post Full Journal Article
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Guidelines 5 Design 6 Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7 Interventions 8 Outcomes 8.1 Primary Outcome 8.2 Secondary Outcomes 9 Criticisms 10 Funding 11 Further Reading
Does early goal-directed therapy before admission to the intensive care unit improve the outcomes of patients with severe sepsis and septic shock?
Early goal-directed therapy in patients with severe sepsis and septic shock reduced in-hospital mortality compared to standard therapy.
Early goal-directed therapy aims to optimize cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. This study assessed the efficacy of implementing early goal-directed therapy before admission to the intensive care unit (ICU) in patients with severe sepsis or septic shock.
Current guidelines recommend early goal-directed therapy as part of the initial management for severe sepsis and septic shock.
- Prospective, randomized, controlled trial - N=263 patients with severe sepsis or septic shock - Early goal-directed therapy (n=130) vs. Standard therapy (n=133) - Setting: Urban emergency department - Enrollment: March 1997 to March 2000
Inclusion Criteria - Adults with severe sepsis, septic shock, or sepsis syndrome presenting to the emergency department - Two of four criteria for systemic inflammatory response syndrome met - Systolic blood pressure ≤90 mm Hg or blood lactate concentration ≥4 mmol per liter
Exclusion Criteria - Age <18, pregnancy, acute cerebral vascular event, acute coronary syndrome, immediate surgical requirement, and other specific conditions
Baseline Characteristics - No significant differences between the two groups
- Early goal-directed therapy or standard therapy conducted for at least six hours pre-ICU - Central venous catheter capable of measuring central venous oxygen saturation was used for early goal-directed therapy - Standard therapy group received critical-care consultation and care based on clinician discretion
Primary Outcome - In-hospital mortality: 30.5% in early goal-directed therapy vs. 46.5% in standard therapy (P=0.009)
- Early goal-directed therapy group had higher central venous oxygen saturation, lower lactate concentration, lower base deficit, and higher pH than standard therapy group (P≤0.02 for all) - Lower mean APACHE II scores, indicating less severe organ dysfunction, in early goal-directed therapy group (P<0.001)
- The trial may have inherent bias from the influence of investigators on the care provided to the early goal-directed therapy group
- Funded by Henry Ford Health Systems Fund for Research, a Weatherby Healthcare Resuscitation Fellowship, equipment from Edwards Lifesciences, and laboratory assays equipment from Nova Biomedical
- Full text of the study available in The New England Journal of Medicine