Early goal-directed therapy
Early goal-directed therapy |
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Early goal-directed therapy (EGDT or EGDT) was introduced by
electronic medical record.[3]
Early goal-directed therapy is a more specific form of therapy used for the treatment of severe
cardiac preload, afterload, and contractility to balance oxygen delivery with an increased oxygen demand before surgery.[4]
Three trials published in 2014/2015 have shown that early goal directed therapy should be abandoned.[5]
Evidence
EGDT, as compared to usual modern care, does not appear to improve outcomes but results in greater expense.[5]
Elements
In the event of
crystalloid solution.[6] Crystalloid solutions are recommended over colloid solutions given the cost and lack in difference of mortality benefit.[6]
Albumin may be considered if large amounts of crystalloid solution is needed.
Indications of a positive response to fluid resuscitation may include:
- a transient increase in central venous pressure (CVP)[6]
- a decrease in heart rate[6]
If hypotension persists despite fluid resuscitation (septic shock) and/or lactate > 4 mmol/L (36 mg/dl), goals in the first 6 hours of resuscitation include:
- Achieve CVP of 8-12 mmHg. Mechanical ventilation, increased abdominal pressure, and preexisting impaired ventricular compliance may require higher CVP targets of 12-15 mmHg[6]
- Achieve superior vena cava oxygen saturation (ScvO2) of > 70% OR mixed venous oxygen saturation (SvO2) of > 65%. If initial fluid resuscitation fails to achieve adequate oxygen saturation, additional options include dobutamine infusion (maximum 20 µg/kg/min) or transfusion of packed red blood cells to a hematocrit ≥ 30%. If a ScvO2 is unavailable, lactate normalization may be used as a surrogate marker. A reduction in lactate by ≥ 10% is noninferior to achieving a ScvO2 of ≥ 70% [7]
- Achieve mean arterial pressure (MAP) ≥ 65mmHg[6] The presence of atherosclerosis or pre-existing uncontrolled hypertension may necessitate a higher MAP target.
- Achieve urine output ≥ 0.5 mL/kg/h[6]
References
- PMID 16356258.
- S2CID 11746826.
- PMID 15183294.
- PMID 11794169.
- ^ PMID 28320242.
- ^ S2CID 34855187. Archived from the original (PDF) on 2015-02-02. Retrieved 2014-11-26 – via Surviving Sepsis Campaign.
- PMID 20179283.