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Early goal-directed therapy: an evidence-based review
Andrew Rhodes1, E David Bennett
1St. George's Hospital, London, UK.
Critical Care Medicine
|November 16, 2004
Summary
These guidelines for severe sepsis management recommend targeting specific hemodynamic and oxygenation goals within the first 6 hours of resuscitation. If goals are unmet, consider blood transfusions or dobutamine, avoiding arbitrary increases in cardiac index.
Area of Science:
- Critical care medicine
- Infectious diseases
- Sepsis management
Background:
- Severe sepsis requires timely and effective management to improve patient outcomes.
- International collaboration is crucial for developing evidence-based guidelines.
- The Surviving Sepsis Campaign aims to enhance awareness and outcomes in severe sepsis.
Purpose of the Study:
- To develop practical management guidelines for early goal-directed therapy in severe sepsis.
- To provide bedside clinicians with actionable recommendations for sepsis resuscitation.
- To establish international consensus on sepsis management strategies.
Main Methods:
- Modified Delphi method and consensus conference involving international experts.
- Systematic literature review graded using a five-level system (A-E).
- Development of recommendations based on evidence and expert consensus.
Main Results:
- Specific targets for central venous pressure, mean arterial pressure, and urine output are recommended within 6 hours.
- Central venous oxygen saturation is a key indicator for guiding therapy.
- Packed red blood cells or dobutamine are suggested for persistent hypoperfusion despite meeting initial targets.
Conclusions:
- Targeted resuscitation is essential in the initial 6 hours of sepsis-induced hypoperfusion.
- Hemodynamic and oxygenation parameters guide the use of interventions like blood products or inotropes.
- Avoidance of arbitrary increases in cardiac index is advised.