EARLY GOAL-DIRECTED THERAPY FOR SEPSIS

Rivers et al, NEJM 345(19):1368-77; Nov 2001.

INCLUSION CRITERIA

1. SIRS (2/4 criteria)

2. SBP ≤ 90 mmHg after 20-30 mg/kg crystalloid OR lactate ≥ 4 mmol/L

EXCLUSION CRITERIA

1) Age <18, pregnancy, 2) CVA, 3) ACS, 4) acute pulmonary edema, 5) status asthmaticus, 6) primary cardiac dysrhythmia, 7) contraindication to CV catheter, 8) acute GI hemorrhage, 9) seizure, 10) overdose, 11) burn, 12) trauma, 13) requirement for immediate surgery, 14) chemotherapy, 15) immunosuppression, 16) DNR

STUDY DESIGN

1. Randomized, partially-blinded

2. Treatments started in ED and continued 6 hrs

3. 288 pts screened, 263 enrolled, 236 treated at least 6 hrs, 133 standard, 130 EGDT

TREAMENTS

1. IVF- 500ml crystalloid Q30min until CVP 8-12

2. Pressors- MAP target ≥ 65mmHg

3. Vasodilators- MAP target ≤ 90mmHg

4. IF ScvO2 < 70%, PRBC to Hct > 30

5. IF ScvO2 still < 70%, DBTA 2.5mcg/kg/min, increase by 2.5 Q30 min until ScvO2 ≥ 70%, MAP < 65, HR > 120, or max dose 20mcg/kg/min

RESULTS

1. In hospital mortality: Std 46.5%, EGDT 30.5%, p = 0.009