title: The Physiology of Early Goal-Directed Therapy for Sepsis.
abstract: In 2001, Rivers and colleagues published a randomized controlled trial of early goal-directed therapy (EGDT) for the treatment of sepsis. More than a decade later, it remains a landmark achievement. The study proved the benefits of early aggressive treatment of sepsis. However, many questions remain about specific aspects of the complex EGDT algorithm. Recently, 3 large trials attempted to replicate these results. None of the studies demonstrated a benefit of an EGDT protocol for sepsis. This review explores the physiologic basis of goal-directed therapy, including the hemodynamic targets and the therapeutic interventions. An understanding of the physiologic basis of EGDT helps reconcile the results of the clinical trials.
authors.affiliation: 1 Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Lief
authors.affiliation: 2 Division of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Arbo
authors.affiliation: 1 Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Berlin
mesh_terms: D000074388:Early Goal-Directed Therapy; D006801:Humans; D018805:Sepsis / Q000628:therapy*
keywords: goal-directed therapy; oxygen consumption; oxygen delivery; sepsis; venous oxygen saturation