Early Goal-Directed Therapy

The early goal-directed therapy ( EGDT , rare are the translations early targeted therapy and early goal-directed therapy in German literature used) is a treatment protocol for severe sepsis . The concept of EGDT was first published in 2001 by the US doctor Emanuel Rivers and colleagues in the New England Journal of Medicine .

description

A double-lumen central venous catheter

The measures of the EGDT are aimed at an early hemodynamic stabilization of the patient. The main target parameters are the mean arterial pressure , the central venous pressure and the central venous oxygen saturation (ScvO ₂ ). In addition, patients receive increased fluid intake, the inotropic dobutamine and more blood transfusions for the first six hours of treatment . The ScvO ₂ value is measured using a central venous catheter fitted with fiber optics in the superior vena cava (superior vena cava) or by means of a central venous blood gas analysis . An ScvO ₂ value of at least 70% is aimed for during treatment . If this does not work with hydration and dobutamine or other catecholamines , the hematocrit value is increased to 30% through blood transfusions. With this treatment regimen, Rivers was able to reduce the 28-day mortality of patients with severe sepsis or septic shock from 46.5 to 30.5% (p = 0.009) and shorten the length of stay in hospital in the surviving patients by 3.8 days.

Early Goal-Directed Therapy should begin in the emergency room and patients should be transferred to the intensive care unit within six hours .

Unfortunately, Early Goal-Directed Therapy failed in subsequent intervention studies.

further reading

• PA Nee, EP Rivers: The end of the line for the Surviving Sepsis Campaign, but not for early goal-directed therapy. In: Emergency medicine journal. Volume 28, Number 1, January 2011, pp. 3-4, ISSN  1472-0213 . doi: 10.1136 / emj.2010.097147 . PMID 21062787 .
• EP Rivers, V. Coba, M. Whitmill: Early goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature. In: Current Opinion in Anesthesiology. Volume 21, Number 2, April 2008, pp. 128-140, ISSN  0952-7907 . doi: 10.1097 / ACO.0b013e3282f4db7a . PMID 18443478 . (Review).
• E. Rivers: The outcome of patients presenting to the emergency department with severe sepsis or septic shock. In: Critical care. Volume 10, Number 4, 2006, p. 154, ISSN  1466-609X . doi: 10.1186 / cc4973 . PMID 16887012 . PMC 1750981 (free full text). (Review).
• BC Ho, R. Bellomo, F. McGain, D. Jones, T. Naka, L. Wan, G. Braitberg: The incidence and outcome of septic shock patients in the absence of early-goal directed therapy. In: Critical care. Volume 10, Number 3, 2006, p. R80, ISSN  1466-609X . doi: 10.1186 / cc4918 . PMID 16704743 . PMC 1550929 (free full text).
• EP Rivers: Early goal-directed therapy in severe sepsis and septic shock: converting science to reality. In: Chest. Volume 129, Number 2, February 2006, pp. 217-218, ISSN  0012-3692 . doi: 10.1378 / chest.129.2.217 . PMID 16478830 .
• M. Bauer: "Early goal-directed therapy" for sepsis - old wine in new bottles? In: The anesthesiologist. Volume 52, 2003, S16-S19, doi: 10.1007 / s00101-003-0589-5

Individual evidence

1. ^ ^{A b} E. Rivers, B. Nguyen, S. Havstad, J. Ressler, A. Muzzin, B. Knoblich, E. Peterson, M. Tomlanovich: Early goal-directed therapy in the treatment of severe sepsis and septic shock. In: The New England Journal of Medicine . Volume 345, Number 19, November 2001, pp. 1368-1377, ISSN  0028-4793 . doi: 10.1056 / NEJMoa010307 . PMID 11794169 .
2. ↑ ^{a b} F. Bloos, K. Reinhart: Central venous oxygen saturation for estimating tissue oxidation. In: Dtsch Med Wochenschr. Volume 129, 2004, pp. 2601-2604. doi: 10.1055 / s-2004-836082
3. ↑ K. Reinhart, FM Brunkhorst, F. Martin: Advances in the therapy of sepsis. In: Dtsch Arztebl. Volume 100, 2003, pp. A-2080 / B-1731 / C-1635.
4. ↑ AE Jones, A. Focht et al. a .: Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock. In: Chest. Volume 132, Number 2, August 2007, pp. 425-432, ISSN  0012-3692 . doi: 10.1378 / chest.07-0234 . PMID 17573521 . PMC 2703721 (free full text).
5. ↑ ARISE Investigators and ANZICS Clinical Trials Group: Goal-Directed Resuscitation for Patients with Early Septic Shock. N Engl J Med 2014; 371: 1496-150 doi: 10.1056 / NEJMoa1404380
6. ↑ Mouncey PR, Osborn TM, et al .: Trial of Early, Goal-Directed Resuscitation for Septic Shock. N Engl J Med 2015; 372: 1301-1311 doi: 10.1056 / NEJMoa1500896