Early Goal-Directed Therapy

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

Description

The measures of EGDT are focused on early hemodynamic stabilization of the patient. The main outcome measures are the mean arterial pressure, central venous pressure and the central venous oxygen saturation ( ScvO2 ). For this, the patients in the first six hours of treatment received an increased fluid intake, frequent the inotrope dobutamine and more blood transfusions. The ScvO2 value using a provided with a fiber optic central venous catheter in the superior vena cava ( superior vena cava ) or central venous blood gases measured. In the treatment of a ScvO2 value of at least 70% is desired. If this is not possible by means of hydration and dobutamine or other catecholamines, the hematocrit value is increased by blood transfusion to 30%. Rivers could with this treatment regimen to reduce the 28- day mortality of patients with severe sepsis or septic shock from 46.5 to 30.5 % (p = 0.009) and shorter hospital stay in surviving patients of 3.8 days.

The Early Goal -Directed Therapy should already begin in the emergency department and the patient should be transferred within six hours to the ICU.

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 21,062,787th
  • Rivers EP, Coba V, Whitmill M.: Early goal -directed therapy in severe sepsis and septic shock: a contemporary review of the literature. In: Current opinion in anaesthesiology. Volume 21, Number 2, April 2008, pp. 128-140, ISSN 0952-7907. doi: 10.1097/ACO.0b013e3282f4db7a. PMID 18,443,478th (Review).
  • E. Rivers: The outcome of patients presenting to the emergency department with severe sepsis or septic shock. In: Critical care (London, England). Volume 10, Number 4, 2006, pp. 154, ISSN 1466 - 609x. doi: 10.1186/cc4973. PMID 16,887,012th 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, pp. R80, ISSN 1466 - 609x. doi: 10.1186/cc4918. PMID 16,704,743th PMC 1550929 (Free full text ).
  • Rivers EP: 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 16,478,830th
  • M. Bauer: "Early goal -directed therapy" of sepsis - Old wine in new bottles? In: The anesthetist. Volume 52, 2003, S16 -S19, doi: 10.1007/s00101-003-0589-5
Digital Object Identifier
251381
de