title: Does Early Goal-Directed Therapy Decrease Mortality Compared with Standard Care in Patients with Septic Shock?
abstract: BACKGROUND
  Current international guidelines for the treatment of patients with severe sepsis and septic shock recommend that patients receive targeted care to various physiologic endpoints, thereby optimizing tissue perfusion and oxygenation. These recommendations are primarily derived from a protocol published >15 years ago, which was viewed by many as complex and was therefore not widely adopted. Instead, many emergency physicians focused on the administration of early antibiotics, source control, aggressive fluid resuscitation, vasoactive medications as needed to maintain mean arterial blood pressure, and careful monitoring of these patients. The primary goal of this literature search was to determine if there is a mortality benefit to the early goal-directed protocol recommended by current international sepsis guidelines compared to current usual care.
  
  
  METHODS
  A MEDLINE literature search was performed for studies published between January 1, 2010 and December 31, 2015. Studies were limited to the English language, human randomized controlled trials, meta-analyses, prospective trials, and retrospective cohort trials that met specific keyword search criteria. Case reports, case series, and review articles were excluded. All selected articles then underwent a structured review by the authors.
  
  
  RESULTS
  Seven thousand four hundred twenty studies were initially screened; after the final application of inclusion and exclusion criteria, 10 studies were formally analyzed. Each study then underwent a rigorous review and evaluation from which a formal recommendation was made.
  
  
  CONCLUSIONS
  There is no difference in mortality between current usual care and the goal-directed approach recommended by current international guidelines for patients with severe sepsis and septic shock.
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Winters
authors.affiliation: Wayne State University, Detroit, Michigan.
authors.forename: Robert
authors.initials: R
authors.lastname: Sherwin
authors.affiliation: University of California at San Diego Medical Center, San Diego, California.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.affiliation: University of California at San Diego Medical Center, San Diego, California.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Wardi
mesh_terms: D004635:Emergency Medicine / Q000379:methods* / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration; D055317:Evidence-Based Practice / Q000379:methods / Q000592:standards*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010347:Patient Care Planning; D012772:Shock, Septic / Q000401:mortality* / Q000628:therapy*
keywords: early goal-directed therapy; protocolized care; sepsis; septic shock; severe sepsis; usual care