January 1, 2008Critical CareOpen Access

Bench-to-bedside review: The initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines – does one size fit all?

Q: What is the clinical evidence from this study?

Study design: Review. Population: Severe sepsis and septic shock. Intervention: Early goal-directed therapy (EGDT) vs. Standard therapy.

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Key result

The hemodynamic component of the Surviving Sepsis Campaign guidelines, based on the Rivers early goal-directed therapy protocol, may not be applicable to all septic patients due to differing physiological profiles.

Why the study?

Does early goal-directed therapy (EGDT) improve mortality in all patients with severe sepsis and septic shock?

Population

Patients with severe sepsis and septic shock

Comparison

Early goal-directed therapy according to the… vs Standard therapy or individualized hemodynamic…

Design

Review

Authors

APAzriel PerelUniversité Paris-Sud

Discussion

Member takes

Implication

Sepsis resuscitation warrants cautious, individualized application rather than universal EGDT; leaves open phenotype-specific trials.

Structured PICO

Does early goal-directed therapy (EGDT) improve mortality in all patients with severe sepsis and septic shock?

Population

Patients with severe sepsis and septic shock

Intervention

Early goal-directed therapy (EGDT) according to the Surviving Sepsis Campaign guidelines (targeting CVP 8-12 mm Hg, MAP ≥65 mm Hg, urine output ≥0.5 mL/kg/hr, ScvO2 ≥70%)

Comparator

Standard therapy or individualized hemodynamic management

Outcome

Mortalityhard clinical

The universal application of the Surviving Sepsis Campaign's early goal-directed therapy protocol may be inappropriate, as the original trial cohort had significantly more severe baseline hypoxia and comorbidities than typical septic patients.

Limitations

The Rivers single-center study has never been repeated
Physiological variables used by SSC guidelines to direct EGDT are not suitable for all septic patients and may be misleading

Cite This Study

Azriel Perel (2008) conducted a review in Severe sepsis and septic shock. Early goal-directed therapy (EGDT) vs. Standard therapy was evaluated. The hemodynamic component of the Surviving Sepsis Campaign guidelines, based on the Rivers early goal-directed therapy protocol, may not be applicable to all septic patients due to differing physiological profiles.

synapsesocial.com/papers/6a848d0625efb1e71e840481 https://doi.org/10.1186/cc6979

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Bench-to-bedside review: The initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines – does one size fit all?

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Bench-to-bedside review: The initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines – does one size fit all?

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider