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Previous Volume 345:1368-1377 November 8, 2001 Number 19 Next

	Full Text PDF Editorial by Evans, T. W. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The purpose of this study was to evaluate the efficacy of early goal-directed therapy before admission to the intensive care unit.

Methods We randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy (as a control) before admission to the intensive care unit. Clinicians who subsequently assumed the care of the patients were blinded to the treatment assignment. In-hospital mortality (the primary efficacy outcome), end points with respect to resuscitation, and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were obtained serially for 72 hours and compared between the study groups.

Results Of the 263 enrolled patients, 130 were randomly assigned to early goal-directed therapy and 133 to standard therapy; there were no significant differences between the groups with respect to base-line characteristics. In-hospital mortality was 30.5 percent in the group assigned to early goal-directed therapy, as compared with 46.5 percent in the group assigned to standard therapy (P=0.009). During the interval from 7 to 72 hours, the patients assigned to early goal-directed therapy had a significantly higher mean (±SD) central venous oxygen saturation (70.4±10.7 percent vs. 65.3±11.4 percent), a lower lactate concentration (3.0±4.4 vs. 3.9±4.4 mmol per liter), a lower base deficit (2.0±6.6 vs. 5.1±6.7 mmol per liter), and a higher pH (7.40±0.12 vs. 7.36±0.12) than the patients assigned to standard therapy (P0.02 for all comparisons). During the same period, mean APACHE II scores were significantly lower, indicating less severe organ dysfunction, in the patients assigned to early goal-directed therapy than in those assigned to standard therapy (13.0±6.3 vs. 15.9±6.4, P<0.001).

Conclusions Early goal-directed therapy provides significant benefits with respect to outcome in patients with severe sepsis and septic shock.

Source Information

From the Departments of Emergency Medicine (E.R., B.N., J.R., A.M., B.K., M.T.), Surgery (E.R.), Internal Medicine (B.N.), and Biostatistics and Epidemiology (S.H., E.P.), Henry Ford Health Systems, Case Western Reserve University, Detroit.

Address reprint requests to Dr. Rivers at the Department of Emergency Medicine, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, or at erivers1{at}hfhs.org.

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• Kahn, J. M., Bates, D. W. (2008). Improving Sepsis Care: The Road Ahead. JAMA 299: 2322-2323 [Full Text]  
• Garcea, G, Jackson, B, Pattenden, C J, Ong, S L, Neal, C P, Dennison, A R, Berry, D P (2008). Progression of early warning scores (EWS) in patients with acute pancreatitis: a re-evaluation of a retrospective cohort of patients. Postgrad. Med. J. 84: 271-275 [Abstract] [Full Text]  
• Lorch, S. A., Millman, A. M., Zhang, X., Even-Shoshan, O., Silber, J. H. (2008). Impact of Admission-Day Crowding on the Length of Stay of Pediatric Hospitalizations. Pediatrics 121: e718-e730 [Abstract] [Full Text]  
• Shermock, K. M., Horn, E., Rice, T. L. (2008). Erythropoietic agents for anemia of critical illness. Am J Health Syst Pharm 65: 540-546 [Abstract] [Full Text]  
• Gao, F., Linhartova, L., Johnston, A. McD., Thickett, D. R. (2008). Statins and sepsis. Br J Anaesth 100: 288-298 [Abstract] [Full Text]  
• Harrisson, S E, Smith, J E, Lambert, A W, Midwinter, M J (2008). Abdominal compartment syndrome: an emergency department perspective. Emerg. Med. J. 25: 128-132 [Abstract] [Full Text]  
• Chawla, L. S., Jagasia, D., Abell, L. M., Seneff, M. G., Egan, M., Danino, N., Nguyen, A., Ally, M., Kimmel, P. L., Junker, C. (2008). Anion Gap, Anion Gap Corrected for Albumin, and Base Deficit Fail to Accurately Diagnose Clinically Significant Hyperlactatemia in Critically Ill Patients. J Intensive Care Med 23: 122-127 [Abstract]  
• Ventetuolo, C. E., Levy, M. M. (2008). Sepsis: A Clinical Update. CJASN 3: 571-577 [Full Text]  
• Ronco, C., Kellum, J. A., Bellomo, R., House, A. A. (2008). Potential Interventions in Sepsis-Related Acute Kidney Injury. CJASN 3: 531-544 [Abstract] [Full Text]  
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• Herget-Rosenthal, S., Saner, F., Chawla, L. S. (2008). Approach to Hemodynamic Shock and Vasopressors. CJASN 3: 546-553 [Full Text]  
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• Parrillo, J. E. (2008). Septic Shock -- Vasopressin, Norepinephrine, and Urgency. NEJM 358: 954-956 [Full Text]  
• Volkova, N. B., Fletcher, C. C., Tevendale, R. W., Munyaradzi, S. M., Elliot, S., Peterson, M. W. (2008). Impact of a Multidisciplinary Approach to Guideline Implementation in Diabetic Ketoacidosis. American Journal of Medical Quality 23: 47-55 [Abstract]  
• Wolf, S. J., Tebb, Z. D., Byyny, R. L., Jones, A. E., Kline, J. A. (2008). Clinical Effectiveness and Early Goal-Directed Therapy for Severe Sepsis and Septic Shock. Chest 133: 584-585 [Full Text]  
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• Durairaj, L., Schmidt, G. A. (2008). Fluid Therapy in Resuscitated Sepsis: Less Is More. Chest 133: 252-263 [Abstract] [Full Text]  
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• Reid, L. E M (2007). Surviving sepsis campaign's recommendations. BMJ 335: 1007-1007 [Full Text]  
• Mackenzie, I., Lever, A. (2007). Management of sepsis. BMJ 335: 929-932 [Full Text]  
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• Hollenberg, S. M. (2007). Vasopressor Support in Septic Shock. Chest 132: 1678-1687 [Abstract] [Full Text]  
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• Giannoudis, P. V., van Griensven, M., Tsiridis, E., Pape, H. C. (2007). The genetic predisposition to adverse outcome after trauma. J Bone Joint Surg Br 89-B: 1273-1279 [Abstract] [Full Text]  
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• Chin, K. M., Channick, R. N., Kim, N. H., Rubin, L. J. (2007). Central Venous Blood Oxygen Saturation Monitoring in Patients With Chronic Pulmonary Arterial Hypertension Treated With Continuous IV Epoprostenol: Correlation With Measurements of Hemodynamics and Plasma Brain Natriuretic Peptide Levels. Chest 132: 786-792 [Abstract] [Full Text]  
• Gray, M. P., Gour, A., Davison, C., Round, J., Murdoch, L. (2007). Indication for tracheal intubation in meningococcal disease and septic shock. Arch. Dis. Child. 92: 827-827 [Full Text]  
• Thomas, Z., Fraser, G. L (2007). An Update on the Diagnosis of Adrenal Insufficiency and the Use of Corticotherapy in Critical Illness. The Annals of Pharmacotherapy 41: 1456-1465 [Abstract] [Full Text]  
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• Baranwal, A. K., Singhi, S. C., Jayashree, M. (2007). A 5-year PICU Experience of Disseminated Staphylococcal Disease, Part 2: Management, Critical Care Needs and Outcome. J Trop Pediatr 53: 252-258 [Abstract] [Full Text]  
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• Dworschak, M. (2007). Adequacy of Brain Oxygen Saturation for Goal-Directed Therapy. Anesth. Analg. 105: 537-538 [Full Text]  
• Doerschug, K. C., Delsing, A. S., Schmidt, G. A., Haynes, W. G. (2007). Impairments in microvascular reactivity are related to organ failure in human sepsis. Am. J. Physiol. Heart Circ. Physiol. 293: H1065-H1071 [Abstract] [Full Text]  
• Angus, D. C. (2007). Caring for the Critically Ill Patient: Challenges and Opportunities. JAMA 298: 456-458 [Full Text]  
• Rubenfeld, G. D., McNamara-Aslin, E., Rubinson, L. (2007). The Pulmonary Artery Catheter, 1967 2007: Rest in Peace?. JAMA 298: 458-461 [Full Text]  
• Sivayoham, N. (2007). Management of severe sepsis and septic shock in the emergency department: a survey of current practice in emergency departments in England. Emerg. Med. J. 24: 422-422 [Abstract] [Full Text]  
• Fong, J. J, Cecere, K., Unterborn, J., Garpestad, E., Klee, M., Devlin, J. W (2007). Factors Influencing Variability in Compliance Rates and Clinical Outcomes Among Three Different Severe Sepsis Bundles. The Annals of Pharmacotherapy 41: 929-936 [Abstract] [Full Text]  
• Brindley, P. G., Simmonds, M., Gibney, R.T. N. (2007). Medical emergency teams: is there M.E.R.I.T?. Canadian J. Anesthesia 54: 389-391 [Full Text]  
• Hebert, P. C., Tinmouth, A., Corwin, H. L. (2007). Controversies in RBC Transfusion in the Critically Ill. Chest 131: 1583-1590 [Abstract] [Full Text]  
• Remick, D. G. (2007). Pathophysiology of Sepsis. Am. J. Pathol. 170: 1435-1444 [Abstract] [Full Text]  
• Lacroix, J., Hebert, P. C., Hutchison, J. S., Hume, H. A., Tucci, M., Ducruet, T., Gauvin, F., Collet, J.-P., Toledano, B. J., Robillard, P., Joffe, A., Biarent, D., Meert, K., Peters, M. J., the TRIPICU Investigators, the Canadian Critical C, (2007). Transfusion Strategies for Patients in Pediatric Intensive Care Units. NEJM 356: 1609-1619 [Abstract] [Full Text]  
• Jha, V., Gutierrez, G., Otero, R. M., Rivers, E. P. (2007). Severe Sepsis and Septic Shock: Should Blood Be Transfused To Raise Mixed Venous Oxygen Saturation?. Chest 131: 1267-1269 [Full Text]  
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• Giuliano, K. K. (2007). Physiological Monitoring for Critically Ill Patients: Testing a Predictive Model for the Early Detection of Sepsis. Am J Crit Care 16: 122-130 [Abstract] [Full Text]  
• Calfee, C. S., Matthay, M. A. (2007). Nonventilatory Treatments for Acute Lung Injury and ARDS. Chest 131: 913-920 [Abstract] [Full Text]  
• Feng, X., Liu, J., Yu, M., Zhu, S., Xu, J. (2007). Hydroxyethyl Starch, but Not Modified Fluid Gelatin, Affects Inflammatory Response in a Rat Model of Polymicrobial Sepsis with Capillary Leakage. Anesth. Analg. 104: 624-630 [Abstract] [Full Text]  
• Turgeon, A. F., Hutton, B., Fergusson, D. A., McIntyre, L., Tinmouth, A. A., Cameron, D. W., Hebert, P. C. (2007). Meta-analysis: Intravenous Immunoglobulin in Critically Ill Adult Patients with Sepsis. ANN INTERN MED 146: 193-203 [Abstract] [Full Text]  
• Lange, M., Broking, K., Hucklenbruch, C., Ertmer, C., Van Aken, H., Lucke, M., Bone, H.-G., Westphal, M. (2007). Hemodynamic effects of titrated norepinephrine in healthy versus endotoxemic sheep. Innate Immunity 13: 53-57 [Abstract]  
• Baxter, A. D., Kanji, S. (2007). Protocol implementation in anesthesia: beta-blockade in non-cardiac surgery patients: [Application d'un protocole en anesthesie : les beta-bloquants chez les patients en chirurgie non cardiaque]. Canadian J. Anesthesia 54: 114-123 [Abstract] [Full Text]  
• Gould, S., Cimino, M. J., Gerber, D. R. (2007). Packed Red Blood Cell Transfusion in the Intensive Care Unit: Limitations and Consequences. Am J Crit Care 16: 39-48 [Abstract] [Full Text]  
• Magder, S., Bafaqeeh, F. (2007). The Clinical Role of Central Venous Pressure Measurements. J Intensive Care Med 22: 44-51 [Abstract]  
• Paton-Gay, J. D., Brindley, P. G., McDermid, R. C. (2007). Best evidence in critical care medicine: Fluid management in acute lung injury: friend or foe?. Canadian J. Anesthesia 54: 73-75 [Full Text]  
• Rittirsch, D., Hoesel, L. M., Ward, P. A. (2007). The disconnect between animal models of sepsis and human sepsis. J. Leukoc. Biol. 81: 137-143 [Abstract] [Full Text]  
• Bellamy, M. C. (2006). Wet, dry or something else?. Br J Anaesth 97: 755-757 [Full Text]  
• Huang, D. T., Yealy, D. M. (2006). Decision Rules and Pneumonia: What Are We "Predicting," and for Whom?. Am. J. Respir. Crit. Care Med. 174: 1169-1170 [Full Text]  
• Espana, P. P., Capelastegui, A., Gorordo, I., Esteban, C., Oribe, M., Ortega, M., Bilbao, A., Quintana, J. M. (2006). Development and Validation of a Clinical Prediction Rule for Severe Community-acquired Pneumonia. Am. J. Respir. Crit. Care Med. 174: 1249-1256 [Abstract] [Full Text]  
• Otero, R. M., Nguyen, H. B., Huang, D. T., Gaieski, D. F., Goyal, M., Gunnerson, K. J., Trzeciak, S., Sherwin, R., Holthaus, C. V., Osborn, T., Rivers, E. P. (2006). Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings.. Chest 130: 1579-1595 [Abstract] [Full Text]  
• Reuben, A D, Appelboam, A V, Higginson, I, Lloyd, J G, Shapiro, N I (2006). Early goal-directed therapy: a UK perspective.. Emerg. Med. J. 23: 828-832 [Abstract] [Full Text]  
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• Bratton, S. L. (2006). Fluid Therapy for Acute Lung Injury. AAP Grand Rounds 16: 53-54 [Full Text]  
• Brindley, P. G., Zhu, N., Sligl, W. (2006). Best evidence in critical care medicine: Early antibiotics and survival from septic shock: it's about time.. Canadian J. Anesthesia 53: 1157-1160 [Full Text]  
• Vinayak, A. G., Levitt, J., Gehlbach, B., Pohlman, A. S., Hall, J. B., Kress, J. P. (2006). Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients.. Arch Intern Med 166: 2132-2137 [Abstract] [Full Text]  
• Russell, J. A. (2006). Management of Sepsis. NEJM 355: 1699-1713 [Full Text]  
• Kellum, J. A., Song, M., Almasri, E. (2006). Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis.. Chest 130: 962-967 [Abstract] [Full Text]  
• Xiao, H., Siddiqui, J., Remick, D. G. (2006). Mechanisms of Mortality in Early and Late Sepsis. Infect. Immun. 74: 5227-5235 [Abstract] [Full Text]