Early goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature

Abstract

Early goal-directed therapy modulates systemic inflammation and results in significant reductions in morbidity, mortality, and healthcare resource consumption. Early goal-directed therapy has been externally validated and is generalizable across multiple healthcare settings. Because of these robust findings, further emphasis should be placed on overcoming logistical, institutional, and professional barriers to implementation which can save the life of one of every six patients presenting with severe sepsis and septic shock.

Treatment with Histone Deacetylase Inhibitor Attenuates MAP Kinase Mediated Liver Injury in a Lethal Model of Septic Shock

“…However, mortality from sepsis is still about 25% [ 1 ]. The progression of infection to septic shock begins with the release of inflammatory mediators at the local site of microbe invasion.…”

An Effective Approach to High Blood Pressure Control

“…Successful examples from other medical areas where a system-level approach has been taken include reducing medical errors and improving patient safety in the hospital setting 15 ; improving the inpatient treatment and outcomes of acute myocardial infarction, heart failure, stroke, and cardiopulmonary resuscitation 16 ; reducing health disparities in the treatment of cardiovascular conditions 16 ; early detection and intervention in sepsis to lower case fatality 17,18 ; and reducing hospital-acquired infections. 19,20 In the case of hypertension, system-level methods can address multiple factors in a coordinated manner:…”

Sepsis in pregnancy and early goal-directed therapy

“…17 This approach in the initial six-hour resuscitation period significantly reduced in-hospital, 28-day and 90-day mortality 17 and has been supported by several other studies. 18 The protocol employs fluid resuscitation and vasopressor therapy in the initial six hours to achieve measurable goals and is supported by the SSC. Goals are central venous pressure (CVP) of 8-12 mmHg, MAP 65 mmHg, urine output 0.5 mL/kg/h and central venous (superior vena cava) (Scv0 2 ) or mixed venous oxygen saturation (SV0 2 ) 70% or 65%, respectively (grade 1C).…”