- Paper Report
- Open Access
The golden hours of septic shock?
- Jeremy Bewley1
© Biomed Central Ltd 2001
- Received: 6 December 2001
- Accepted: 11 December 2001
- Published: 19 December 2001
- septic shock
Goal directed haemodynamic optimisation has been demonstrated to increase mortality when initiated on the intensive care unit (ICU). This study is original as it recruits patients particularly early, in the hospital emergency department before admission to the ICU. Secondly it uses central venous saturation as the resuscitation end point.
A reduced hospital mortality was found in the treatment of severe sepsis, from 46.5% with standard treatment to 30.5% with early goal directed therapy. The proposed reason for this was a significantly higher mean central venous saturation (77% vs 66%). This was achieved through increased use of fluids (5 litres vs 3.5 litres), blood (64% vs 19%), and dobutamine (14% vs 1%) during the first 6 hours of care in the emergency department.
263 patients with severe sepsis who were either in a state of shock or had a lactate >4mmol/L were randomised between an initial 6 hours of either early goal directed therapy or standard therapy. Both groups were managed with arterial and central venous monitoring. The goal directed group had a target central venous saturation of >70% in addition to the standard targets of central venous pressure (CVP) 8-12 mmHg, mean arterial pressure 65-90mmHg, and urine output >0.5ml/Kg/min.
Evans T: Hemodynamic and Metabolic Therapy in Critically Ill Patients,
N Engl J Med 2001, 345:1417-1418.