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Early goal-directed therapy for all UK emergency departments?
  1. P B Sherren
  1. Correspondence to Dr P B Sherren, Department of Anaesthesia and Intensive Care, Queen's Hospital, Romford, UK; petersherren{at}gmail.com

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I read with great interest the article by Lyon et al1 on early goal-directed therapy (EGDT) in Scottish emergency departments (ED).

While I would commend any effort to instigate early optimisation and critical care for patients with severe sepsis and septic shock, I would suggest a note of caution before any ED in the UK adopts the use of EGDT.2 The application of the results found in the single-centre randomised controlled trial conducted in the USA by Rivers et al2 remains controversial. For this reason, EGDT received a grade 1C recommendation (ie, ‘strong’ recommendation with ‘low level’ of evidence) in the 2008 Surviving Sepsis Campaign guidelines.3 The two major concerns …

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