Early Goal Directed Therapy (EGDT)

Early Goal Directed Therapy is a treatment used for severe sepsis and septic shock. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with an increased oxygen demand ^[1]

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Early goal-directed therapy can reduce mortality in patients with severe sepsis and septic shock.

Elements

In the event of hypotension and/or lactate > 4 mmol/L, then deliver an initial minimum of 20 ml/kg of crystalloid (or colloid equivalent).

Apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure (MAP) > 65 mm Hg

In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate > 4 mmol/L (36 mg/dl):

• Achieve central venous pressure (CVP) of > 8 mm Hg
• Achieve central venous oxygen saturation (ScvO2) of > 70%

References

1. ^ Rivers, 2001 http://scalpel.stanford.edu/articles/Goal%20directed%20therapy.pdf