Early Goal-Directed Therapy for Patients with Sepsis

Once severe sepsis and septic shock are established, interventions to reverse the syndrome frequently are ineffective. Detroit investigators examined whether early goal-directed therapy, instituted immediately in the emergency department (ED), reduced mortality in septic patients.

The researchers enrolled 263 patients who presented to the ED with at least 2 of 4 criteria for systemic inflammatory response syndrome and either systolic blood pressure no higher than 90 mm Hg or blood lactate levels of at least 4 mmol/L. Patients were randomized to standard care (with critical care consultation and inpatient admission as soon as possible) or to early goal-directed therapy for at least 6 hours in the ED. For the latter group, a protocol outlined …