Sepsis Update 3

EGDT

Early Goal Directed Therapy (EGDT) is a management approach on Severe Sepsis and Septic Shock where Oxygen Demand is matched with Oxygen Delivery by manipulating Cardiac Preload, Afterload, and Contractility.

The goal within 6 hours of patient's presentation:

1. CVP 8-12 mmHg
2. MAP ≥65 mmHg
3. ScvO2 or SvO2 ≥ 70% or ≥ 65% respectively
4. UO ≥0.5 mL/kg/hour
   

EGDT originated from a landmark paper by Emanuel Rivers, et al (pdf version at stanford.edu) published in 2001 by NEJM. The approach itself is not original, GDT already being done in ICU. But this time, intervention starts before ICU (where else could be earlier than the ER) within 6 hours of patient's presentation. Randomized to EGDT vs control group (standard treatment), patients are then followed up to 72 hours -- with significant results on:

1. lower mortality by 16%
2. improved end-points of resuscitation
   (lower lactate, higher pH, higher ScvO2)
   
3. lower APACHE II scores (6.3 vs 13)

Subsequent studies with external validations showed decreases in mortality, morbidity, and health care resource consumption. [Curr Opin Anaesthesiol 2008;21:128-40.]

The purpose of EGDT is to detect and treat occult global tissue hypoxia before organ damage becomes irreversible.

Sepsis Series: Next Post, Sepsis Update 4, Steps in EGDT

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This Sepsis learning module link might interest you