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Early goal-directed therapy: on terminal life support?
1Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA. marikpe@evms.edu
The American Journal of Emergency Medicine
|February 18, 2010
Summary
Early goal-directed therapy (EGDT), a sepsis bundle standard, involves fluid resuscitation and oxygen monitoring. However, this study argues the core components of EGDT are fundamentally flawed despite the sound resuscitation concept.
Area of Science:
- Critical care medicine
- Emergency medicine
- Sepsis management
Background:
- Early goal-directed therapy (EGDT) is the standard for severe sepsis and septic shock.
- The Sepsis Bundle, comprising EGDT elements, is a quality of care indicator.
- EGDT mandates fluid resuscitation and oxygen saturation targets.
Purpose of the Study:
- To critically evaluate the established components of the Sepsis Bundle.
- To challenge the efficacy of current EGDT protocols in severe sepsis management.
Main Methods:
- Review and critical analysis of the scientific literature supporting EGDT.
- Examination of the physiological targets and interventions within the Sepsis Bundle.
Main Results:
- While the principle of early resuscitation is valid, the specific elements of the Sepsis Bundle are deemed problematic.
- The study identifies critical flaws in the prescribed methods of EGDT.
Conclusions:
- The current Sepsis Bundle, despite its widespread adoption, requires re-evaluation.
- Fundamental changes to EGDT protocols may be necessary for improved sepsis patient outcomes.
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