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(title:EARLY GOAL-DIRECTED THERAPY AND SEVERE SEPSIS AND SEPTIC SHOCK)

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1. The Role of Early Goal-Directed Therapy in Severe Sepsis and Septic Shock

The Role of Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Emergency Medicine > Journal Club > Archive > July 2015 Toggle navigation July 2015 The Role of Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Vignette You are working a shift in TCC one busy afternoon when a patient is brought in by EMS for flank pain and a fever. You enter the room the find a 60­‐year female with a history of hypertension who is in no distress. She complains of dysuria, right flank pain (...) of fluid, and you don’t plan to place a central line for pressors, so wonder if it’s really necessary. After discussion with the attending you decide to hold off on the central line and admit the patient to the ICU, but after your shift you consider your question again and begin searching the literature for answers. PICO Question #1 Population: Adult patients with severe sepsis or septic shock Intervention: Early goal-directed therapy Comparison: Usual care or other standardized protocols Outcome

2015 Washington University Emergency Medicine Journal Club

2. Comparison of Early Goal-Directed Therapy With Usual Care for Severe Sepsis and Septic Shock

Comparison of Early Goal-Directed Therapy With Usual Care for Severe Sepsis and Septic Shock Systematic Review Snapshot TAKE-HOME MESSAGE Compared with unstructured usual care, early goal-directed therapy does not decrease mortality in patients with severe sepsis or septic shock. Comparison of Early Goal-Directed Therapy WithUsualCareforSevereSepsisandSeptic Shock EBEM Commentators Michael Gottlieb, MD John Bailitz, MD Department of Emergency Medicine Cook County Hospital Chicago, IL Results (...) , with differences settled by consensus with a third ANNALS OF EMERGENCY MEDICINE DECEMBER 2015 632 Annals of Emergency Medicine Volume 66, no. 6 : December 2015transfusions, as expected in the control groups in which these interventions were not mandated. Commentary Severe sepsis and septic shock occur frequently and are a leading cause of death in the United States. 1 In 2001, Rivers et al 2 described a speci?c early goal- directed therapy protocol to reduce mortality in patients with severe sepsis or septic

2015 Annals of Emergency Medicine Systematic Review Snapshots

3. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department

Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?

2011 PedsCCM Evidence-Based Journal Club

4. Prognostic utility of plasma lactate measured between 24 and 48 h after initiation of early goal-directed therapy in the management of sepsis, severe sepsis, and septic shock Full Text available with Trip Pro

Prognostic utility of plasma lactate measured between 24 and 48 h after initiation of early goal-directed therapy in the management of sepsis, severe sepsis, and septic shock Based on the proven efficacy of lactate in predicting mortality and morbidity in sepsis when measured early in the resuscitative protocol, our group hypothesized that this utility extends later in the course of care. This study sought to investigate the prognostic potential of plasma lactate clearance measured 24-48 h (...) after the initiation of treatment for nonsurgical patients with sepsis, severe sepsis, and septic shock.Plasma lactate values, measured 24-48 h after the initiation of treatment, were collected in nonsurgical septic, severe septic, and septic shock patients. The primary outcome was 30-day mortality, while secondary outcomes included requirements for vasopressors and boluses of intravenous fluids. Analysis of these three outcomes was performed while controlling for clinical severity as measured

2016 Journal of intensive care

6. Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE Full Text available with Trip Pro

Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care (...) a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate

2016 Critical Care

7. Samu Save Sepsis: Early Goal Directed Therapy in Pre Hospital Care of Patients With Severe Sepsis and/or Septic Shock

Samu Save Sepsis: Early Goal Directed Therapy in Pre Hospital Care of Patients With Severe Sepsis and/or Septic Shock Samu Save Sepsis: Early Goal Directed Therapy in Pre Hospital Care of Patients With Severe Sepsis and/or Septic Shock - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number (...) of saved studies (100). Please remove one or more studies before adding more. Samu Save Sepsis: Early Goal Directed Therapy in Pre Hospital Care of Patients With Severe Sepsis and/or Septic Shock (SSS) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02473263 Recruitment Status : Active, not recruiting

2015 Clinical Trials

8. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy Full Text available with Trip Pro

The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy Sepsis, including severe sepsis and septic shock, is a major cause of morbidity and mortality. Albumin and C-reactive protein (CRP) are considered as good diagnostic markers for sepsis. Thus, initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients (...) with severe sepsis and septic shock.We conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and who had received a standardized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock, from November 2007 to February 2013, at a tertiary hospital in Seoul, Korea. The outcome measured was 180-day all-cause mortality. A multivariate Cox proportional hazard model was used to identify the independent risk

2015 PloS one

9. Investigation of the Role of Brain Natriuretic Peptide and Lactate in Early Goal-directed Therapy for Patients With Severe Sepsis and Septic Shock

: Investigation of the Role of Brain Natriuretic Peptide and Lactate in Early Goal-directed Therapy for Patients With Severe Sepsis and Septic Shock Study Start Date : February 2012 Estimated Primary Completion Date : January 2013 Estimated Study Completion Date : January 2013 Resource links provided by the National Library of Medicine related topics: available for: Groups and Cohorts Go to Group/Cohort Intervention/treatment 1 sepsis and septic shock patients Other: check BNP and lactate we will collect (...) Investigation of the Role of Brain Natriuretic Peptide and Lactate in Early Goal-directed Therapy for Patients With Severe Sepsis and Septic Shock Investigation of the Role of Brain Natriuretic Peptide and Lactate in Early Goal-directed Therapy for Patients With Severe Sepsis and Septic Shock - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies

2012 Clinical Trials

10. Outcomes from implementing early goal-directed therapy for severe sepsis and septic shock : a 4-year observational cohort study. (Abstract)

Outcomes from implementing early goal-directed therapy for severe sepsis and septic shock : a 4-year observational cohort study. The aim of this study was to determine the outcome of patients with severe sepsis and septic shock who did and did not receive early goal-directed therapy (EGDT) in the emergency department (ED). The primary end point was the in-hospital mortality rate. The secondary end points were lengths of stay in the ICU and in hospital.Patients with sepsis who satisfied two (...) . The mortality rate in the EGDT group was 22.7% compared with 42.9% in the non-EGDT group (P=0.004). The length of stay in ICU was [(median and interquartile range)] 3D(5) versus 4D(8), P value less than 0.0001. There was no difference in the length of in-hospital stay.Initiating EGDT in the ED in patients with severe sepsis and septic shock was associated with a significant reduction in in-hospital mortality and length of stay in ICU.

2012 European Journal of Emergency Medicine

11. Randomized controlled trials testing sepsis bundle use with early goal directed therapy for the treatment of sepsis, severe sepsis, and septic shock: a systematic review and meta-analysis

Randomized controlled trials testing sepsis bundle use with early goal directed therapy for the treatment of sepsis, severe sepsis, and septic shock: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites (...) . No control group 5. Combination therapy or contamination 6. Not about analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data are not reported or unclear, we

2014 PROSPERO

12. Early Goal-directed Therapy (EGDT) for Severe Sepsis/Septic Shock: Which Components of Treatment are More Difficult to Implement in a Community-based Emergency Department? (Abstract)

Early Goal-directed Therapy (EGDT) for Severe Sepsis/Septic Shock: Which Components of Treatment are More Difficult to Implement in a Community-based Emergency Department? Early goal-directed therapy (EGDT) has been shown to reduce mortality in patients with severe sepsis/septic shock, however, implementation of this protocol in the emergency department (ED) is sometimes difficult.We evaluated our sepsis protocol to determine which EGDT elements were more difficult to implement in our community (...) -based ED.This was a non-concurrent cohort study of adult patients entered into a sepsis protocol at a single community hospital from July 2008 to March 2009. Charts were reviewed for the following process measures: a predefined crystalloid bolus, antibiotic administration, central venous catheter insertion, central venous pressure measurement, arterial line insertion, vasopressor utilization, central venous oxygen saturation measurement, and use of a standardized order set. We also compared

2011 Journal of Emergency Medicine

13. [The effect of early goal-directed therapy on treatment of critical patients with severe sepsis/septic shock: a multi-center, prospective, randomized, controlled study]. (Abstract)

[The effect of early goal-directed therapy on treatment of critical patients with severe sepsis/septic shock: a multi-center, prospective, randomized, controlled study]. To investigate the effect of early goal-directed therapy (EGDT) on treatment of critical patients with severe sepsis/septic shock.A multi-center, prospective, randomized, controlled study was deployed. Totally 314 critical patients, from eight comprehensive hospitals in Zhejiang Province admitted during January, 2005 to January (...) , 2008, suffering from severe sepsis/septic shock were randomized into conventional treatment group (n=151) and EGDT group (n=163), the patients of the former underwent fluid resuscitation guided by central venous pressure (CVP), systolic blood pressure (SBP) or mean artery pressure (MAP) and urinary output (UO), and the latter guided by CVP, SBP or MAP and UO plus central venous oxygen saturation (ScvO2). The patients were treated with fluid, blood transfusions and cardiac stimulants in a period

2010 Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue Controlled trial quality: uncertain

14. One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study Full Text available with Trip Pro

One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study Early structured resuscitation of severe sepsis has been suggested to improve short term mortality; however, no previous study has examined the long-term effect of this therapy. We sought to determine one year outcomes associated with implementation of early goal directed therapy (EGDT) in the emergency department (ED) care (...) ). The primary outcome of 1 year mortality was observed in 39/79 (49%) pre-implementation subjects and 77/206 (37%) post-implementation subjects (difference 12%; P = 0.04).Implementation of EGDT for the treatment of ED patients with severe sepsis and septic shock was associated with significantly lower mortality at one year.

2009 Critical Care

15. Implementation of early goal-directed therapy for severe sepsis and septic shock: a decision analysis

to the clinical data, the authors presented a reasonably transparent analysis and it is likely that the results reflected the available evidence. Funding Supported by grants from the National Institutes of Health, USA. Bibliographic details Huang D T, Clermont G, Dremsizov T T, Angus D C. Implementation of early goal-directed therapy for severe sepsis and septic shock: a decision analysis. Critical Care Medicine 2007; 35(9): 2090-2100 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Cost-Benefit (...) Implementation of early goal-directed therapy for severe sepsis and septic shock: a decision analysis Implementation of early goal-directed therapy for severe sepsis and septic shock: a decision analysis Implementation of early goal-directed therapy for severe sepsis and septic shock: a decision analysis Huang D T, Clermont G, Dremsizov T T, Angus D C Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains

2007 NHS Economic Evaluation Database.

16. Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?

2001 PedsCCM Evidence-Based Journal Club

17. Implementation of early goal-directed therapy for severe sepsis and septic shock: A decision analysis. (Abstract)

Implementation of early goal-directed therapy for severe sepsis and septic shock: A decision analysis. Early goal-directed therapy (EGDT) reduced mortality from septic shock in a single-center trial. However, implementation of EGDT faces several barriers, including perceived costs and logistic difficulties. We conducted a decision analysis to explore the potential costs and consequences of EGDT implementation.Estimates of effectiveness and resource use were based on data from the original trial (...) and published sources. Implementation costs and lifetime projections were modeled from published sources and tested in sensitivity analyses. We generated incremental cost-effectiveness ratios from the hospital (short-term) and U.S. societal (lifetime) perspectives, excluding nonhealthcare costs, and applying a 3% annual discount.Simulation of an average U.S. emergency department.Total of 1,000 simulation cohorts (n = 263 for each cohort) of adult patients with severe sepsis/septic shock.EGDT under three

2007 Critical Care Medicine

18. Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock. Full Text available with Trip Pro

Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock. To determine the clinical effectiveness of implementing early goal-directed therapy (EGDT) as a routine protocol in the emergency department (ED).Prospective interventional study conducted over 2 years at an urban ED. Inclusion criteria included suspected infection, criteria for systemic inflammation, and either systolic BP < 90 (...) 69%, p < 0.001) during the initial resuscitation. In-hospital mortality was 21 of 79 patients (27%) before intervention, compared with 14 of 77 patients (18%) after intervention (absolute difference, - 9%; 95% confidence interval, + 5 to - 21%).Implementation of EGDT in our ED was associated with a 9% absolute (33% relative) mortality reduction. Our data provide external validation of the clinical effectiveness of EGDT to treat sepsis and septic shock in the ED.

2007 Chest

19. Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings. Full Text available with Trip Pro

Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings. Studies of acute myocardial infarction, trauma, and stroke have been translated into improved outcomes by earlier diagnosis and application of therapy at the most proximal stage of hospital presentation. Most therapies for these diseases are instituted prior to admission to an ICU; this approach to the sepsis patient has been lacking. In response, a trial comparing early (...) goal-directed therapy (EGDT) vs standard care was performed using specific criteria for the early identification of high-risk sepsis patients, verified definitions, and a consensus-derived protocol to reverse the hemodynamic perturbations of hypovolemia, vasoregulation, myocardial suppression, and increased metabolic demands. Five years after the EGDT publication, there has been much discussion generated with regard to the concepts of EGDT, as well as debate fueled regarding diagnostic

2006 Chest

20. Early goal-directed therapy, corticosteroid, and recombinant human activated protein C for the treatment of severe sepsis and septic shock in the emergency department. (Abstract)

Early goal-directed therapy, corticosteroid, and recombinant human activated protein C for the treatment of severe sepsis and septic shock in the emergency department. To describe our experience with early goal-directed therapy (EGDT), corticosteroid administration, and recombinant human activated protein C (rhAPC) administration in patients with severe sepsis or septic shock and an Acute Physiology and Chronic Health Evaluation (APACHE) II score > or =25 in the emergency department (ED (...) was 25.0%.EGDT, corticosteroid administration, and rhAPC administration are feasible in the ED setting. While these evidence-based therapies individually have been shown to improve outcomes for patients with severe sepsis or septic shock, further studies are needed to examine their combined effectiveness during the early stages of this disease.

2006 Academic Emergency Medicine

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