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Yao Lu, Han Zhang, Fang Teng, Wen-Jun Xia, Gui-Xiang Sun, Ai-Qing Wen
INTRODUCTION: The Surviving Sepsis Campaign guidelines recommend early goal-directed therapy (EGDT) for the resuscitation of patients with sepsis; however, the recent evidences quickly evolve and convey conflicting results. We performed a meta-analysis to evaluate the effect of EGDT on mortality in adults with severe sepsis and septic shock. METHODS: We searched electronic databases to identify randomized controlled trials that compared EGDT with usual care or lactate-guided therapy in adults with severe sepsis and septic shock...
October 18, 2016: Journal of Intensive Care Medicine
Mathieu Jozwiak, Xavier Monnet, Jean-Louis Teboul
Sepsis bundles represent key elements of care regarding the diagnosis and treatment of patients with septic shock and allow ones to convert complex guidelines into meaningful changes in behavior. Sepsis bundles endorsed the early goal-directed therapy (EGDT) and their implementation resulted in an improved outcome of septic shock patients. They induced more consistent and timely application of evidence-based care and reduced practice variability. These benefits mainly depend on the compliance with sepsis bundles, highlighting the importance of dedicated performance improvement initiatives, such as multifaceted educational programs...
September 2016: Annals of Translational Medicine
Lindsay Lief, John Arbo, David A Berlin
In 2001, Rivers and colleagues published a randomized controlled trial of early goal-directed therapy (EGDT) for the treatment of sepsis. More than a decade later, it remains a landmark achievement. The study proved the benefits of early aggressive treatment of sepsis. However, many questions remain about specific aspects of the complex EGDT algorithm. Recently, 3 large trials attempted to replicate these results. None of the studies demonstrated a benefit of an EGDT protocol for sepsis. This review explores the physiologic basis of goal-directed therapy, including the hemodynamic targets and the therapeutic interventions...
October 5, 2016: Journal of Intensive Care Medicine
Bernd Saugel, Wolfgang Huber, Axel Nierhaus, Stefan Kluge, Daniel A Reuter, Julia Y Wagner
In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these "organ dysfunction syndromes" is a key therapeutic component. It needs, however, to be differentiated between "early goal-directed therapy" (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and "hemodynamic management" using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to "usual care" in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation...
2016: BioMed Research International
Matthias Kochanek, Alexander Shimabukuro-Vornhagen, Michael von Bergwelt-Baildon, Boris Böll
The incidence of sepsis increases in Germany from latest DRG evaluations and also the mortality is still at a high level. The aim of the new Sepsis - 3 definition is to optimize the identification and initiation of therapy. The treatment algorithms by Rivers (EGDT) are getting old. Rapid identification of septic patients, rapid administration of antibiotics and rapid therapy management are crucial.
September 2016: Deutsche Medizinische Wochenschrift
Federico Coccolini, Massimo Sartelli, Fausto Catena, Marco Ceresoli, Giulia Montori, Luca Ansaloni
BACKGROUND: Since the incorporation of the early hemodynamic resuscitation in septic shock according to the early goal-directed therapy (EGDT) protocol among the 6-hour resuscitation bundle of the Surviving Sepsis Campaign guidelines, a great debate has been raised about the issue. The present meta-analysis aims to determine whether the resuscitative phase really takes advantages by being performed with EGDT. METHODS: A systematic review with meta-analysis of randomized controlled trials (RCTs) of EGDT versus usual care in patients with early septic shock was performed...
November 2016: Journal of Trauma and Acute Care Surgery
Steven Q Simpson, Melissa Gaines, Youness Hussein, Robert G Badgett
: Studies and meta-analyses conflict regarding the use of early goal-directed therapy (EGDT) for septic shock. We sought to clarify the conflict by performing a living systematic review and meta-regression. METHODS: We performed a meta-analysis and explored heterogeneity with meta-regression. We conformed with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and qualified strength of evidence with a Grading of Recommendations Assessment, Development and Evaluation profile...
June 29, 2016: Journal of Critical Care
Geun Ho Oh, Sung Phil Chung, Yoo Seok Park, Jung Hwa Hong, Hye Sun Lee, Hyun Soo Chung, Je Sung You, Jong Woo Park, Incheol Park
PURPOSE: We evaluated the mean platelet volume (MPV) to platelet ratio to determine its significance as a prognostic marker for early mortality in critically ill patients with suspected sepsis receiving early goal-directed therapy (EGDT). METHODS: We retrospectively reviewed the records from a prospective EGDT registry and screened eligible adult patients who were admitted to the emergency department (ED) with severe sepsis and/or septic shock. The MPV/platelet ratio was estimated as the MPV value divided by the platelet count on each day of hospitalization...
August 8, 2016: Shock
Panita Worapratya, Jutharat Joraluck, Apisit Wanjaroenchaisuk, Prasit Wuthisuthimethawee
OBJECTIVE: Determine the appropriateness of broad-spectrum antibiotics applied in severe sepsis and septic shock in an emergency room and its impact on the survival rate. MATERIAL AND METHOD: This was a prospective observational study in an emergency room setting at a tertiary care facility where early goal-directed therapy (EGDT) was applied for resuscitation of severe septic and septic shock patients. The data recorded were the initial vital signs, SAP II score, time of EGDT goals achieved (ScvO₂> 70), time of antibiotics initiated, type of antibiotics used, organisms that were identified, source of infection, initial and final diagnosis, and outcome of treatment...
May 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Hyung Jung Oh, Min Hyung Kim, Jin Young Ahn, Nam Su Ku, Jung Tak Park, Sang Hoon Han, Jun Yong Choi, Seung Hyeok Han, Tae-Hyun Yoo, Young Goo Song, Shin-Wook Kang, June Myung Kim
PURPOSE: The purpose of our study was to investigate the timing of continuous renal replacement therapy (CRRT) application, based on the interval between the start of early goal-directed therapy (EGDT) and CRRT initiation, to ascertain whether the timing was an independent predictor of mortality in patients with septic acute kidney injury (AKI). MATERIALS AND METHODS: An observational retrospective cohort study was conducted of 60 patients (>18 years old) who had been admitted to the emergency department and received resuscitation according to the standard EGDT algorithm for severe sepsis and septic shock, and who were treated with CRRT due to septic AKI, between June 2008 and February 2013 at a tertiary hospital in Seoul, Korea...
October 2016: Journal of Critical Care
Xi-Wen Zhang, Jian-Feng Xie, Ai-Ran Liu, Ying-Zi Huang, Feng-Mei Guo, Cong-Shan Yang, Yi Yang, Hai-Bo Qiu
BACKGROUND: Early goal-directed therapy (EGDT) has become an important therapeutic management in early salvage stage of septic shock. However, splenic organs possibly remained hypoperfused and hypoxic despite fluid resuscitation. This study aimed to evaluate the effect of EGDT on hepatic perfusion in septic shock patients. METHODS: A prospective observational study was carried out in early septic shock patients who were admitted to Intensive Care Unit within 24 h after onset and who met all four elements of the EGDT criteria after treatment with the standard EGDT procedure within 6 h between December 1, 2012 and November 30, 2013...
July 20, 2016: Chinese Medical Journal
Ole Broch, Arne Carstens, Matthias Gruenewald, Edith Nischelsky, Lukas Vellmer, Berthold Bein, Heiko Aselmann, Markus Steinfath, Jochen Renner
BACKGROUND: Today, most of the preemptive haemodynamic optimization algorithms are based on variables associated with invasive techniques like arterial cannulation. The non-invasive NexfinTM technology is able to estimate continuous cardiac index (CI) and pulse pressure variation (PPV). However, the efficiency of an early goal directed therapy (EGDT) algorithm based on non-invasive variables has to be proven. The aim of our study was to investigate the feasibility of a non-invasive driven EGDT protocol and its impact on patient's outcome...
June 28, 2016: Minerva Anestesiologica
Bing Liu, Xun Ding, Jiong Yang
BACKGROUND: Many investigators have reproduced the mortality reduction shown in the original trial of early goal directed therapy (EGDT) in patients with severe sepsis and/or septic shock. Three large randomized controlled trials (RCTs) found neutral results when compared to usual care and a modified form of EGDT. Some have interpreted these studies as a reason to question the efficacy of EGDT. OBJECTIVES: The purpose of this study was to comprehensively examine the effect of EGDT in the treatment of severe sepsis and/or septic shock in the literature...
November 2016: Current Medical Research and Opinion
Panita Worapratya, Apisit Wanjaroenchaisuk, Jutharat Joraluck, Prasit Wuthisuthimethawee
BACKGROUND: Since early goal-directed therapy (EGDT) became standard care in severe sepsis and septic shock patients in intensive care units many years ago, we suppose that the survival rate of severe sepsis and septic shock patients improves if the resuscitative procedure is quickly implemented and is initiated in the emergency room. OBJECTIVE: We aimed at recording emergency department time to improve our patient care system as well as determine the rate at which EGDT goals can be achieved...
2016: Open Access Emergency Medicine: OAEM
Rong-fang Xie
OBJECTIVE: To explore the effect of early goal-directed therapy (EGDT) combined with Yiqi Fumai Lyophilized Powder (YFLP) on central venous-arterial carbon dioxide difference [P(cv-a)CO2] and central venous oxygen saturation (S(cv)O2) in patients with septic shock. METHODS: Totally 50 patients with septic shock were assigned to the control group and the treatment group according to random digit table, 25 cases in each group. Patients in the control group received treatment according to EGDT principle...
March 2016: Chinese Journal of Integrated Traditional and Western Medicine
Jun Lu, Xing Wang, Qiuhua Chen, Mingqi Chen, Lu Cheng, Linfeng Dai, Hua Jiang, Zhiguang Sun
BACKGROUND: The Surviving Sepsis Campaign has recommended early goal-directed therapy (EGDT) as an essential strategy to decrease mortality among patients with severe sepsis and septic shock. However, three latest multicenter trials failed to show its benefit in the patients with severe sepsis and septic shock. This article was to evaluate the effect of EGDT on the mortality of patients with severe sepsis and septic shock. METHODS: Relevant studies from PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were identified from January 1, 2001 to June 13, 2015...
May 15, 2016: Journal of Surgical Research
Wei Sun, Hongxun Yuan, Youzhong An
Nowadays, severe infection has become one of the common problems in clinic. The morbidity of severe sepsis and septic shock is increasing, which becomes a big threat to patients with burn wounds or chronic diseases. It has become a key subject about how to cure severe sepsis and septic shock. In recent years, mortality of patients in such condition has declined slightly, which might be attributed to the application of early goal-directed therapy (EGDT) in certain degree. This article reviews application of EGDT in severe sepsis and septic shock, in order to analyze its effectiveness and boundedness, as well as predict its development...
May 2016: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Chang Li, Dong Yun
OBJECTIVE: To evaluate the effect of the early goal-directed therapy (EGDT) on mortality in patients with septic shock, and to analyze the risk factors of mortality. METHODS: A retrospective controlled study was conducted. Complete clinical data of patients with septic shock admitted to emergency intensive care unit (EICU) of Sichuan Provincial People's Hospital from May 1994 to December 2014 were recorded and analyzed. According to the International Guidelines for Management of Severe Sepsis and Septic Shock ( SSC ) with the time of promulgation as dividing point, the patients were divided into two groups as before and after the publication of the guideline, i...
November 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Xiaoyun Liu, Wenli Ji, Jifeng Wang, Tao Pan
Septic shock, also known as infectious or toxic shock, is a medical condition caused by severe infection and sepsis. Early identification, timely diagnosis and effective treatments are imperative to prevent this medical condition. The aim of the present study was to examine the application of pulse index continuous cardiac output (PiCCO) technique in the treatment of septic shock patients. Fifty septic shock patients were randomly divided into the conventional detection group (group C, n=25) and the PiCCO detection group (group P, n=25)...
April 2016: Experimental and Therapeutic Medicine
Jing-Yuan Xu, Qi-Hong Chen, Song-Qiao Liu, Chun Pan, Xiu-Ping Xu, Ji-Bin Han, Jian-Feng Xie, Ying-Zi Huang, Feng-Mei Guo, Yi Yang, Hai-Bo Qiu
BACKGROUND: Whether early goal-directed therapy (EGDT) improves outcome in severe sepsis and septic shock remains unclear. We performed a meta-analysis of existing clinical trials to examine whether EGDT improved outcome in the resuscitation of adult sepsis patients compared with control care. METHODS: We searched for eligible studies using MEDLINE, Elsevier, Cochrane Central Register of Controlled Trials, and Web of Science databases. Studies were eligible if they compared the effects of EGDT versus control care on mortality in adult patients with severe sepsis and septic shock...
August 2016: Anesthesia and Analgesia
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