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Protocol driven sepsis management—time for a rethink?
  1. Christiane Vorwerk,
  2. Timothy J Coats
  1. Academic Unit of Emergency Medicine, University of Leicester, Leicester, UK
  1. Correspondence to Dr Christiane Vorwerk, Emergency Department, Leicester Royal Infirmary, Leicester LE1 5WW, UK; cv28{at}le.ac.uk

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Sepsis remains a major public healthcare burden and a potent killer. In 2001, Rivers and colleagues published a landmark paper about the early management of severe sepsis, which greatly changed our approach.1 The study's concept of ‘early goal directed therapy (EGDT)’, a protocol driven early intervention using pre-defined resuscitation endpoints for central venous pressure, mean arterial pressure and central venous oxygen saturation, was found to significantly reduce mortality from severe sepsis. Though Rivers et al1 were not the first to look at goal directed treatment in severe sepsis, they were the first to describe its implementation at the ‘front door’ rather than on the intensive care unit.

The mortality reduction in Rivers' study was so impressive that the concept of EGDT was adopted by the Surviving Sepsis Campaign (SSC). The SSC, an international body of experts and established critical care organisations, aimed to improve the diagnosis, management and survival of patients with sepsis. Their main goal, a 25% reduction in sepsis mortality by 2009, was to be achieved by changing clinical behaviour through the implementation of clinical guidelines (sepsis bundles) and practice improvement programmes. The concept of care bundles, which is not unique to sepsis, originated from an extensive critical care literature review aiming to identify …

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