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A Reproducible Intensive Care Unit-Oriented Endotoxin Model in Rats
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Does Early Goal-Directed Therapy Decrease Mortality Compared with Standard Care in Patients with Septic Shock?

Michael E Winters1, Robert Sherwin2, Gary M Vilke3

  • 1Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.

The Journal of Emergency Medicine
|November 24, 2016
PubMed
Summary
This summary is machine-generated.

Current sepsis guidelines recommend a complex goal-directed protocol for severe sepsis and septic shock. However, this study found no mortality difference between this protocol and usual care, suggesting simpler approaches are equally effective.

Keywords:
early goal-directed therapyprotocolized caresepsisseptic shocksevere sepsisusual care

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Area of Science:

  • Critical Care Medicine
  • Emergency Medicine
  • Infectious Diseases

Background:

  • International guidelines for severe sepsis and septic shock recommend a complex early goal-directed protocol.
  • This protocol, over 15 years old, has seen limited adoption.
  • Physicians often prefer a simpler approach focusing on antibiotics, fluids, and monitoring.

Purpose of the Study:

  • To compare the mortality benefit of the international guideline-recommended early goal-directed protocol versus usual care for severe sepsis and septic shock.

Main Methods:

  • A MEDLINE search identified English-language human randomized controlled trials, meta-analyses, and cohort trials published from 2010-2015.
  • Case reports, case series, and reviews were excluded.
  • Ten studies were formally analyzed after screening 7,420 initial studies.

Main Results:

  • Analysis of 10 selected studies revealed no significant difference in mortality.
  • The mortality rates were comparable between the goal-directed protocol group and the usual care group.

Conclusions:

  • There is no demonstrable mortality benefit to the early goal-directed protocol compared to current usual care for severe sepsis and septic shock.
  • Current usual care practices appear to be as effective as the guideline-recommended protocol in reducing mortality.