Our approach is based on several major randomized trials that used a protocol-based approach (ie, early goal-directed therapy [EGDT]) to treating sepsis. Components of the protocols usually included the early administration of fluids and antibiotics (within one to six hours) using the following targets to measure the response: central venous oxyhemoglobin saturation (ScvO2) ≥70 percent, central venous pressure (CVP) 8 to 12 mmHg, mean arterial pressure (MAP) ≥65 mmHg, and urine output ≥0.5 mL/kg/hour.
Although all trials (except for one, did not show a mortality benefit to EGDT, it is thought that the lack of benefit was explained by an overall improved outcome in both control and treatment groups, and to improved clinical performance by trained clinicians in academic centers during an era that followed an aggressive sepsis education and management campaign. In support of this…
