The outcome of patients presenting to the emergency department with severe sepsis or septic shock.
Although multiple studies of acute myocardial infarction, trauma, and stroke have been translated into improved outcomes by applying diagnosis and therapy at the most proximal stage of hospital presentation (before intensive care unit arrival), this approach to the sepsis patient has been lacking. In response to this, a trial comparing early goal-directed therapy (EGDT) versus standard care was performed using internally and externally validated criteria for early identification of high risk patients, established definitions, and a consensus-derived protocol to reverse the hemodynamic perturbations of hypovolemia, vasoregulation, myocardial suppression and increased metabolic demands. That trial of EGDT resulted in significant reductions in morbidity, mortality, vasopressor use, and health care resource consumption. The end-points used in the protocol and the outcome results were subsequently externally validated, revealing similar or better mortality benefit. This commentary examines the rational and validation for the use of early markers of illness severity. Current evidence support the endpoints in the EGDT protocol, external validity in regards to outcome benefit and the universal need to improve the quality of care for early sepsis.
Rivers
Emanuel
E
Emergency Medicine and Critical Care, Henry Ford Hospital, Detroit, Michigan, USA. ERIVERS1@hfhs.org
D004636:Emergency Service, Hospital; D006801:Humans; D018805:Sepsis / Q000453:epidemiology / Q000628:therapy; D012772:Shock, Septic / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome