Effect of early goal directed therapy in the treatment of severe sepsis and/or septic shock

Abstract

EGDT significantly reduced mortality in patients with severe sepsis and/or septic shock over 15 years since its publication. Recent studies examining usual care with EGDT have similar mortality benefit because of the diminished treatment effect. This treatment effect is diminished for multiple reasons. With progress in the management of this disease the benefit of EGDT on overall mortality has become comparable with the usual care for sepsis patients. This is because many of the components of EGDT have been incorporated into usual care protocols. As a result, the conclusion that EGDT is ineffective cannot be made. A more rigorous RCT which adjusts for the factors that narrows the treatment effect between groups is required. Given the current state of sepsis care and equipoise that exist, this would be difficult.

Trends in the epidemiology of purple urine bag syndrome: A systematic review

“…Therefore, this progress may be attributed to the new recommendation of EGDT, which may achieve aggressive correction of septic shock when combined with early appropriate antibiotic administration. Nonetheless, the mortality rate of patients with severe sepsis declined following the implementation of EGDT ( 84 – 87 ). A recent meta-analysis study also concluded that important factors contributing to improved outcome are time-to-first antibiotic administration and appropriate antibiotic use ( 88 ).…”

Impact of obesity on short- and long-term mortality in patients with sepsis: A retrospective analysis of the large clinical database MIMIC-III

“…Methods We retrospectively analyzed 11,499 32.2%, and 29.6%; p<0.001), 1-year mortality, (64.6%, 56.8%, 52.5%, and 46.7%; p<0.001), and in-hospital mortality (35.4%, 34.3%, 31.6%, and 29.9%; p=0.018). In addition, obese patients had notably longer mechanical ventilation periods and intensive care unit and hospital lengths of stay.…”

“…Previous studies have considered the relationship between obesity, and short-and long-term prognosis of patients admitted to the intensive care unit (ICU) [9]. However, research on the relationship between obesity and short-term and long-term prognosis in patients with sepsis diagnosed by ICU based on large data samples is relatively limited [10,11].…”

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

“…EGDT was found to significantly benefit mortality as compared with standard care in 5 of the 13 studies (3,15,17,27,35). Of these, four were performed in China and one was the Rivers seminal study.…”

“…Note that EGDT also implies extensive "bundled" treatments including immediate fluid resuscitation, early and adequate source control and/or initiation of antibiotics, and tailored use of vasopressors, inotropes and blood transfusion (39). Although study protocols dictated that the control group was not guided by ScvO 2 monitoring but directed by the treating physician, many components of the SSC bundle could have been introduced (35,40), which may explain why no significant difference was found between standard and EGDT-driven care. As an example, baseline ScvO 2 in these studies was higher than 70% in most of patients, which may reflect an aggressive medical therapy before randomization or the inclusion of less severe patients than in the Rivers study.…”