The end of early-goal directed therapy?

Circulating Biologically Active Adrenomedullin (bio-ADM) Predicts Hemodynamic Support Requirement and Mortality During Sepsis

“…Aggressive fluid therapy and hemodynamic support to restore peripheral organ perfusion based upon pre-defined hemodynamic targets are the cornerstone of the management of patients with severe sepsis and septic shock (22). Despite these standardized procedures, several experimental and clinical evidence clearly suggest that this approach may have harmful effects, and should be individualized (28)(29)(30). Several clinical studies have indeed shown an independent association between an increasingly positive fluid balance and reduced survival in patients with sepsis (31,32).…”

Could resuscitation be based on microcirculation data? No

“…Within the framework of early goal-directed therapy (EGDT), patients with more favourable microcirculation data have been reported to have superior clinical outcomes in an observational study [10]. However, it is uncertain what role these data may have, especially within the context of increased scepticism about EGDT for patient resuscitation [11,12]. There is further uncertainty regarding exactly which treatments might restore the microcirculation during resuscitation, with preclinical data being heterogeneous, and with high risk of bias [13].…”