Outcomes from implementing early goal-directed therapy for severe sepsis and septic shock

Abstract

Initiating EGDT in the ED in patients with severe sepsis and septic shock was associated with a significant reduction in in-hospital mortality and length of stay in ICU.

The MISSED score, a new scoring system to predict Mortality In Severe Sepsis in the Emergency Department

“…Ideally, those satisfying any of the criteria defining severe sepsis should receive aggressive resuscitation in the ED. Whilst aggressive resuscitation, such as implementing EGDT in the ED may be beneficial to patients by reducing mortality and reducing length of stay [9,11], it is also invasive and labour intensive in the ED. It must, therefore, be focused on those patients who would benefit the most.…”

“…Resuscitation of these patients is time sensitive [1,[7][8][9] with patients who receive early aggressive resuscitation having a decreased mortality rate.…”

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

“…Unlike the negative results from recently published RCTs, most observational studies demonstrated that SSC bundle adherence was associated with a reduced mortality rate (9,(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74), but without significantly increasing medical cost (75). Over a 7.5-year period running from 2005 till 2012, Levy et al found that compliance to the SSC bundle resulted in a 25% relative mortality risk reduction (76).…”

Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis

“…Unlike the results of observational studies, 14,15 which were proposed as evidence supporting the ongoing use of EGDT, 2,13 this prospectively defined analysis of individual patient data relies exclusively on random assignment, avoiding biases related to confounding by indication, regression to the mean, or secular trends in sepsisrelated mortality. 16,17 This collaboration among trial groups also shows that key methodologic aspects of independently conducted research can be harmonized in advance, facilitating the generation of a richer evidence base to guide clinicians dealing with complex conditions such as septic shock.…”