Critical Care and Shock

Early goal-directed therapy in the management of severe sepsis/septic shock in an academic emergency department in Malaysia

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Introduction: Early goal-directed therapy (EGDT) is a haemodynamic optimization protocol that is proven to reduce mortality in cases of severe sepsis/septic shock.

Objective: The objective of this study is to determine whether EGDT can be implemented successfully in an academic hospital emergency department with the existing resources and expertise.

Methods: A prospective study was conducted at Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (ED UKMMC) from March until May 2009. Sixteen patients were enrolled in this study. The patients were subjected to EGDT with the aim to achieve all defined haemodynamic endpoints within the first 6 hours of diagnosis. Data was collected regarding achievability of these endpoints.

Results: The mean age of the patients was 58.4±17.4 and the mean APACHE II score on arrival was 24.2±7.6. The diagnosis of severe sepsis was made at a mean time of 1.2±1.0 hours from the time of arrival to the emergency department. All patients successfully had a central venous line inserted within 6 hours of diagnosis and the mean time to insertion was 0.7±0.8 hour. The target CVP range was achieved within an average of 2.1±2.2 hours from diagnosis. Out of the 16 patients, 12 (87.5%) achieved the target CVP goal. All patients achieved an MAP of 65 mmHg within the first 6 hours of diagnosis with an average time of 1 hour from time of diagnosis. Eleven (68.8%) patients successfully achieved the target central vein oxygen saturation of 70% and the mean time to achieve this goal was 1.3±0.9 hours. Mean ScvO2 achieved was 81.6±6.7. Thus, the success rate for achieving all EGDT goals within the first 6 hours of diagnosis was 62.5% (n=10).

Conclusion: This study demonstrates that EGDT can be implemented in the ED with the current resources and expertise.