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Assessment of physical findings that are traditionally relied on in the management of shock, such as vital signs and urinary output, often fails to detect cellular hypoxia. These investigators evaluated whether early optimization of cardiac preload, afterload, and contractility affects mortality and multiorgan dysfunction.
Two hundred sixty-three patients presenting to an ED with sepsis were randomized to goal-directed therapy (130) or usual care (133). Goal-directed therapy involved specific manipulation of fluids and pressors to optimize central venous pressure, mean arterial pressure, oxygen saturation, hematocrit, and central venous oxygen; these interventions were carried out for at least 6 hours (average time, 8 hours) in the ED. Usual…