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Early goal-directed therapy: can the emergency department deliver
  1. Tim Nutbeam1,
  2. Ron Daniels2
  1. 1Princess Royal Hospital Telford, West Midlands Deanery Emergency Medicine Rotation, Birmingham, UK
  2. 2Critical Care and Anaesthesia, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Tim Nutbeam, West Midlands Deanery, 43 Middlepark Drive, Northfied, Birmingham B31 2FL, UK; timnutbeam{at}

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We read with interest the original article Early goal-directed therapy: can the emergency department deliver by Lyon et al.1 The authors identify elements of the ‘Early Goal Directed Therapy’ (EGDT) component of the Surviving Sepsis Campaign's ‘Resuscitation Bundle’, which emergency medicine (EM) registrars may fail to deliver due to lack of appropriate skills and the 4-h wait.

A previous UK survey of EM and acute medicine consultants2 (n=234) yielded similar results: lactate measurement, central venous pressure (CVP) monitoring and inotrope administration present major barriers to implementation. Recognising poor compliance, …

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  • Competing interests RD was chair of the UK Surviving Sepsis Campaign at the time of the study cited. He has received honoraria and consultancy fees, and been reimbursed by Eli Lilly & Co, the manufacturer of the Critical Care drug Xigris, for attending a number of conferences. The education programme, Survive Sepsis, received unrestricted educational grants in 2007 from Eli Lilly and from Astra Zeneca, manufacturers of the antibiotic Meropenem; Edwards Lifesciences, manufacturer of the Vigileo/Flotrac cardiac output monitoring system; and Vygon UK, manufacturers of central venous catheters. Neither RD nor Survive Sepsis have received funds during the last 24 months. TN received a single honorarium from Eli Lilly and Co. in 2007 for a presentation at a European meeting.

  • Provenance and peer review Not commissioned; not externally peer reviewed.