title: Outcomes from implementing early goal-directed therapy for severe sepsis and septic shock :  a 4-year observational cohort study.
abstract: OBJECTIVE
  The aim of this study was to determine the outcome of patients with severe sepsis and septic shock who did and did not receive early goal-directed therapy (EGDT) in the emergency department (ED). The primary end point was the in-hospital mortality rate. The secondary end points were lengths of stay in the ICU and in hospital.
  
  
  METHODS
  Patients with sepsis who satisfied two of the four systemic inflammatory response criteria and who either had a lactate of greater than 4 mmol/l or a systolic blood pressure of less than 90 mmHg after 20-30 ml/kg of fluid, were included. Patients who had EGDT commenced, and all patients who were admitted to ICU who met EGDT criteria over a 4-year period from 1 January 2006 to 31 December 2009, were studied.
  
  
  RESULTS
  One hundred and seventy-four patients with sepsis met the criteria for EGDT. Ninety-seven patients had EGDT commenced in the ED. The mortality rate in the EGDT group was 22.7% compared with 42.9% in the non-EGDT group (P=0.004). The length of stay in ICU was [(median and interquartile range)] 3D(5) versus 4D(8), P value less than 0.0001. There was no difference in the length of in-hospital stay.
  
  
  CONCLUSIONS
  Initiating EGDT in the ED in patients with severe sepsis and septic shock was associated with a significant reduction in in-hospital mortality and length of stay in ICU.
authors.affiliation: Department of Emergency Medicine, St George's Healthcare NHS Trust, London, UK. Narani.Sivayoham@stgeorges.nhs.uk
authors.forename: Narani
authors.initials: N
authors.lastname: Sivayoham
authors.forename: Andrew
authors.initials: A
authors.lastname: Rhodes
authors.forename: Thiagarajan
authors.initials: T
authors.lastname: Jaiganesh
authors.forename: Nellis
authors.initials: N
authors.lastname: van Zyl Smit
authors.forename: Samer
authors.initials: S
authors.lastname: Elkhodhair
authors.forename: Sarah
authors.initials: S
authors.lastname: Krishnanandan
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D012772:Shock, Septic / Q000401:mortality*; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult