Early goal-directed therapy

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Early goal-directed therapy

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:

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