Early goal-directed therapy: do we have a definitive answer?

Excerpt

Early goal-directed therapy (EGDT) for the treatment of septic shock was first proposed in 2001 by Rivers et al. [1]. These authors reported that patients with hypotension refractory to a fluid challenge of 20–30 ml/kg of crystalloids over 30 min or with plasma lactate levels of at least 4 mEq/l and who were treated to restore and maintain a central venous oxygen saturation (ScvO₂) of greater than 70 % had lower 28-day mortality rates than control patients (33 vs 49 %). That publication generated considerable enthusiasm but also much debate. The resuscitation protocol was incorporated into the Surviving Sepsis Campaign (SSC) guidelines [2] and several uncontrolled studies reported similar improvements in outcome [3‐5]. However, concerns were raised about the single-center nature of the trial, the limited sample size (263 patients), the multiple interventions proposed in the EGDT package making it difficult to differentiate which was most effective, and the potential influence of confounding factors including the increased presence of doctors at the bedside of patients randomized to the intervention. …