CanadiEM MVP Infographic Series – Early Goal Directed Therapy in the Treatment of Sepsis

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In this issue of the MVP Infographic Series, we feature: “Early-Goal Directed Therapy in the Treatment of Severe Sepsis and Septic Shock” by Rivers et al.

This study demonstrated the importance of early recognition of septic patients and the use of early-goal directed therapy (EGDT) to decrease associated morbidity and mortality. At the time this study was published, cases of sepsis were increasing steadily while the associated mortality was not improving with new developments and research1. The investigators hypothesized that mortality in septic shock was caused by poor oxygen delivery to organs and that normalization of this parameter would improve survival2. Their solution to this issue, EGDT, was aimed at manipulating certain values such as central venous pressure, mean arterial pressure and urine output. The ultimate goal was to maintain central venous oxygen saturation. The study’s results proved to be quite ground-breaking as overall mortality was decreased by 16% in the EGDT group compared to standard therapy3.

Nowadays, sepsis care has changed dramatically and newer studies have not replicated the dramatic mortality difference using EGDT4. Nonetheless, the Rivers Trial remains a landmark study in the evolution of sepsis care.

Friedman G, Silva E, Vincent J. Has the mortality of septic shock changed with time. Crit Care Med. 1998;26(12):2078-2086. [PubMed]
Beal A, Cerra F. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction. JAMA. 1994;271(3):226-233. [PubMed]
Rivers E, Nguyen B, Havstad S, et al. Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. N. 2001;345(19):1368-1377. doi:10.1056/nejmoa010307
A Randomized Trial of Protocol-Based Care for Early Septic Shock. N. 2014;370(18):1683-1693. doi:10.1056/nejmoa1401602

Vanessa Knight

Vanessa Knight is a second year Family Medicine resident at McGill University, Montreal, QC. Academically, her interests are in continuing education and visual adaptation of learning tools.
Alvin is currently a PGY5 in the FRCP EM program at McMaster University. He serves as Director of Design for CanadiEM and has interests in knowledge translation and health innovation.