Chest
Original ResearchTranslating Research to Clinical Practice: A 1-Year Experience With Implementing Early Goal-Directed Therapy for Septic Shock in the Emergency Department
Section snippets
Study Design and Setting
This was a retrospective cohort study at an urban academic medical center (Cooper University Hospital, Camden, NJ), with an ED volume of 48,000 annual patient visits. The institution has an emergency medicine residency program and a multispecialty critical care medicine fellowship program.
Cooper University Hospital adopted EGDT as a best practice model for sepsis resuscitation on January 1, 2004. The EGDT program at Cooper University Hospital is a collaborative effort in which the emergency
Primary Analysis
Of 45 records identified from the EGDT registry in 2004, 23 records did not meet the criteria for hypotension in the ED (normotensive with lactate elevation), leaving 22 EGDT subjects in the primary analysis. All 22 subjects were admitted from the ED to the ICU service. Patient characteristics for the EGDT group are displayed in the right column of Table 2.
All end points of EGDT were successfully achieved for 20 of 22 EGDT cases. In the remaining two cases, CVP and MAP targets were achieved,
Discussion
The transfer of research innovations to clinical practice has historically been a slow and complex process.789 This is an issue of high priority because research transfer is one of the major mechanisms by which medical advances can lead to health-care improvement. Early hemodynamic optimization with an EGDT protocol is a research innovation that has been shown to reduce mortality in severe sepsis and septic shock1 and is now recommended for use by international consensus.2 The relatively early
ACKNOWLEDGMENT
The authors thank the nurses in the ED and ICU at Cooper University Hospital for their dedication in implementing state-of-the-art care for our critically ill patients with sepsis.
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Dr. Trzeciak is a consultant and member of the Speakers Bureau for Edwards Lifesciences and Eli Lilly. Dr. Dellinger is a consultant for GlaxoSmithKline and a member of the Speakers Bureau for Edwards Lifesciences and Eli Lilly. Dr. Zanotti is a member of the Speakers Bureau for Eli Lilly. Dr. Parrillo is a consultant for Edwards Lifesciences, GlaxoSmithKline, and Ortho-Biotech, and has research grants from GlaxoSmithKline.
There was no source of external funding for this study. The authors' institution received an unrestricted educational grant from Edwards Lifesciences for an education program prior to protocol implementation.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).