The Concept of Early Goal-Directed Therapy in Sepsis Syndrome
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- Category: Vol. 79, March 2011
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The Concept of Early Goal-Directed Therapy in Sepsis Syndrome,HAZEM EL-AKABAWY, MERVAT KHALAF, FAHEEM RAGAB and MICHAEL NAEEM
Abstract
Background: Early goal-directed therapy (EGDT) used in the treatment of sepsis is essentially a comprehensive strategy that involves the early identification of high-risk septic patients and performance of a consensus-derived pro-tocol to reverse the hemodynamic perturbations of hypov-olemia, vasoregulation, myocardial suppression, and increased metabolic load by adjustment of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand.
Objective: To evaluate the concept of EGDT; provided at the earliest stages of severe sepsis and septic shock; regarding the clinical course and final outcome.
Methods: A prospective, randomized, single center study were conducted on 60 patients admitted with severe sepsis and septic shock, 30 patients were treated according to the protocol of EGDT which consists of aggressive hemodynamic support during the first 6 hours after sepsis is recognized, to achieve certain physiologic targets, the other 30 patients received only conventional sepsis treatment. Both groups were matched by APACHE IV score (within the 1 st 6 hours). MODS and SOFA scores were calculated at baseline and everyday until ICU discharge or death. Clinical outcome (duration of stay in the ICU, need for mechanical ventilation, need for inotropic/vasopressor support, need for haemodialysis, and final outcome of survival/mortality rates) were recorded for all patients.
Results: EGDT, provided at earliest stage of severe sepsis or septic shock, (1) significantly improved patient outcome as indicated by significant reduction of SOFA and MODS scores from the second day of hospital stay (mean 1st day 9.5± 3.02 Vs. mean 2nd day 7.8±3.66; p=0.006 for SOFA and mean1st day 7.93±1.75 Vs. mean2nd day 6.86±2.44; p=0.03 in MODS), (2) significantly reduced the length of ICU stay for surviving patients (8.2±3.1 Vs. 39±43 d; p=0.02), (3) significantly reduced the 28 days mortality (40% Vs. 73.3%; p=0.009), (4) non significantly reduced frequency of those needed vasopressor support (p=0.1) and non significantly reduced frequency of those needed MV (p=0.24).
Conclusion: EGDT provide significant benefits in patients with severe sepsis and septic shock.