Sepsis goal-directed therapy

Rivers E, Nguyen B, Havstad S, et al. Early Goal-directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001 345 1368-1377. 

An important overall approach for treatment of sepsis is goal-directed therapy. Mortality can be reduced by early placement and use of a central venous catheter, increased fluid volume administration, dobutamine therapy if needed, and red blood cell transfusion, to achieve specific physiologic goals in the first 6 hours. Evidence-based treatment recommendations for sepsis and septic shock from the Surviving Sepsis campaign are presented in Table 45-3. 

Early goal-directed therapy with aggressive fluid resuscitation in the emergency department within the first 6 hours of presentation improves survival in sepsis and septic shock. 

Early goal-directed therapy of sepsis consisting of hemodynamic monitoring with a central venous catheter, volume resuscitation, inotropic therapy, and red blood cell transfusions demonstrated a significant clinical outcome benefit with a 16% absolute reduction in 28-day mortality. 

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