Early Goal-Directed Therapy in Septic Shock

Is it Sepsis?
Patient to be included in the protocol needs to fulfill the SIRS criteria:
Temp °C greater than or equal to 38°C or less than 36°C, HR greater than 90 bpm, Resp. rate greater than 20 breaths/min or PaCO2 than 32 mm Hg, and WBC greater than 12,000 per mm3 or less than 4000 per mm3 or the presence of more than 10 percent immature bands. Fulfillment of two of four criteria is required for enrollement in the treatment protocol.

Does it fit the protocol?
You should check the full list of inclusion and exlcusion criteria on this page.

Central Line Placement
Next step is to prepare for a central line placement. Check out our Procedure Guide page.

What is the literature?
Below is the original article by Rivers et al. published in NEJM in 2001 which started the thinking about the Early Goal-Directed Therapy (EGDT).

Early Goal-Directed Therapy in the Treatment of Septic Shock.
NEJM Volume 345:1368-1377 November 8, 2001

Central venous oxygen saturation monitoring by SVC catheter brought better results than standard care guided by Swan-Ganz catheter. You can check the editorial as well. Dr.Kalepu presented a Journal Club focused on the article, click here for the PowerPoint file.

Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update
Crit Care Med 2004 September; 32(9):1928-1948

Use the Special PreSep Catheter
PreSep catheter (PreSep stands for Pre-Sepsis, i.e. early sepsis)

PreSep manufacturer Edwards Co. has a very useful teaching module which will guide you step by step through the process. Download the PreSep catheter brochure as a reminder, the protocol is included.

Remember to calibrate the catheter BEFORE you insert it in IJ / SC vein. ICU nurses will be trained to do this.

More Cases
Click to see real cases from Drexel University, Pennsylvania.

References:
Evidence-Based Guidelines Issued to Detect and Treat Sepsis. Medscape, 06/2007.

Related
More on the Surviving Sepsis Guidelines 2004-2008. Notes from Dr. RW, 02/2008.