Review

. 2017 Feb;9(2):392-405.

doi: 10.21037/jtd.2017.02.10.

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

Zhongheng Zhang¹, Yucai Hong¹, Nathan J Smischney², Han-Pin Kuo³, Panagiotis Tsirigotis⁴, Jordi Rello⁵, Win Sen Kuan⁶, Christian Jung⁷, Chiara Robba⁸, Fabio Silvio Taccone⁹, Marc Leone¹⁰, Herbert Spapen¹¹, David Grimaldi⁹, Sven Van Poucke¹², Steven Q Simpson¹³, Patrick M Honore¹⁴, Stefan Hofer¹⁵, Pietro Caironi¹⁶

Affiliations

¹ Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
² Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
³ Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
⁴ 2nd Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁵ CIBERES, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Spain.
⁶ Emergency Medicine Department, National University Hospital, National University Health System, Singapore and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁷ University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany.
⁸ Neurosciences Critical Care Unit, Box 1, Addenbrooke's Hospital, Cambridge, UK.
⁹ Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
¹⁰ Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
¹¹ Intensive Care Department, University Hospital, Vrije Universiteit, Brussels, Belgium.
¹² Department of Anesthesiology, Emergency Medicine, Critical Care and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
¹³ Division of Pulmonary and Critical Care Medicine, University of Kansas, Kansas, USA.
¹⁴ Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium.
¹⁵ Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.
¹⁶ Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.

PMID: 28275488
PMCID: PMC5334094
DOI: 10.21037/jtd.2017.02.10

Review

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

Zhongheng Zhang et al. J Thorac Dis. 2017 Feb.

. 2017 Feb;9(2):392-405.

doi: 10.21037/jtd.2017.02.10.

Authors

Affiliations

¹ Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
² Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
³ Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
⁴ 2nd Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁵ CIBERES, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Spain.
⁶ Emergency Medicine Department, National University Hospital, National University Health System, Singapore and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁷ University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany.
⁸ Neurosciences Critical Care Unit, Box 1, Addenbrooke's Hospital, Cambridge, UK.
⁹ Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
¹⁰ Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
¹¹ Intensive Care Department, University Hospital, Vrije Universiteit, Brussels, Belgium.
¹² Department of Anesthesiology, Emergency Medicine, Critical Care and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
¹³ Division of Pulmonary and Critical Care Medicine, University of Kansas, Kansas, USA.
¹⁴ Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium.
¹⁵ Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.
¹⁶ Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.

PMID: 28275488
PMCID: PMC5334094
DOI: 10.21037/jtd.2017.02.10

Abstract

Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.

Keywords: Early goal directed therapy (EGDT); evidence; sepsis; septic shock.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

**Figure 1**
Typical structured protocol for early goal directed therapy (the workflow was drawn according to study protocols of included RCTs). CVC, central venous catheter; CVP, central venous pressure; ITBVI, intrathoracic blood volume index; RBC, red blood cell; MAP, mean arterial pressure; SAP, systolic arterial pressure; Lac, lactate; LCR, lactate clearance rate; UO, urine output; Hb, hemoglobin; JVP, jugular venous pressure; Hct, hematocrit.

**Figure 2**
Forest plot showing pooled effects of EGDT on mortality outcome. Subgroup analysis showed that old trials were more likely to report beneficial effect than new trials. EGDT, early goal directed therapy. The figure was from the reference (33).

See this image and copyright information in PMC

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References

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

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

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