Chest
Volume 129, Issue 2, February 2006, Pages 217-218
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Editorials
Early Goal-Directed Therapy in Severe Sepsis and Septic Shock: Converting Science to Reality

https://doi.org/10.1378/chest.129.2.217Get rights and content

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    Since then, many studies have discussed the relationship between lactate and sepsis.31–33 Lactate-guided resuscitation is highly valuable for sepsis resuscitation, rather than hemodynamic-guided resuscitation, as it is a parameter for microcirculation.34–36 Serial lactate monitoring is generally accepted in the management of sepsis and cardiac surgery for congenital heart disease.37–39

  • Emergency department sepsis huddles: Achieving excellence for sepsis benchmarks in New York State

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    Prior to 2001, a standard for the management of sepsis in the ED did not exist [1]. With the publication of Dr. Emmanuel Rivers' paper on Early Goal Directed Therapy [2], it appeared that this early management led to a significant decrease in mortality. Dr. Rivers formally established the need for emergent resuscitation in the setting of severe sepsis.

  • Which one is a better predictor of ICU mortality in septic patients? Comparison between serial serum lactate concentrations and its removal rate

    2018, Journal of Critical Care
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    Septic shock is one of the leading causes of mortality in intensive care units worldwide. There are some concerns regarding the international recommendation of early goal-directed therapy (EGDT) [1,2], based on optimization of central venous O2 saturation (ScvO2), mean arterial pressure, central venous pressure and urine output in terms of decreasing mortality [3-5]. However, it was determined that EGDT was not superior to standard sepsis management [3-5].

  • Cooling the Fire. Resuscitated Sudden Death

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    Scvo2 must be measured from a central venous catheter placed in the subclavian or internal jugular vein. The recommended target of Scvo2 is greater than 70%.4,12 Regarding lactate, there is no significant difference between arterial and venous samples; values greater than 2 mmol/L are considered abnormal.

  • Evaluation of a modified early goal-directed therapy protocol

    2010, American Journal of Emergency Medicine
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    Other institutions have also been able to show a reduction in mortality after implementing standard protocols for the ED treatment of the septic patient [6-10]. Despite these promising results, EGDT has not been widely implemented [11-13]. In May 2005, we implemented a modified EGDT protocol at our large, suburban community teaching hospital.

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Dr. Rivers has done consultant work for Biosite, Inc., Chiron, the Lilly Corporation, and Edwards Lifesciences over the last year. As a consultant, he helped advise the company in developing, but holds no patent rights to, catheters used for early, goal-directed therapy.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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