title: Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002.
abstract: Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.
authors.affiliation: Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Zhongheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Yucai
authors.initials: Y
authors.lastname: Hong
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Smischney
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
authors.forename: Han-Pin
authors.initials: HP
authors.lastname: Kuo
authors.affiliation: 2nd Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsirigotis
authors.affiliation: CIBERES, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Emergency Medicine Department, National University Hospital, National University Health System, Singapore and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Win Sen
authors.initials: WS
authors.lastname: Kuan
authors.affiliation: University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jung
authors.affiliation: Neurosciences Critical Care Unit, Box 1, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Chiara
authors.initials: C
authors.lastname: Robba
authors.affiliation: Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.affiliation: Intensive Care Department, University Hospital, Vrije Universiteit, Brussels, Belgium.
authors.forename: Herbert
authors.initials: H
authors.lastname: Spapen
authors.affiliation: Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
authors.forename: David
authors.initials: D
authors.lastname: Grimaldi
authors.affiliation: Department of Anesthesiology, Emergency Medicine, Critical Care and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Sven
authors.initials: S
authors.lastname: Van Poucke
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Kansas, Kansas, USA.
authors.forename: Steven Q
authors.initials: SQ
authors.lastname: Simpson
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Honore
authors.affiliation: Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hofer
authors.affiliation: Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caironi
keywords: Early goal directed therapy (EGDT); evidence; sepsis; septic shock