Early interventions in severe sepsis and septic shock: a review of the evidence one decade later Full Text
Minerva Anestesiologica, 06/14/2012
Rivers EP et al. – This review will examine one decade of evidence for the components of the resuscitation bundle (RB) examining its impact on systemic inflammation, the progression of organ failure, health care resource consumption and mortality in severe sepsis and septic shock.
- The outcomes of acute myocardial infarction, trauma, and stroke have improved by implementing processes that provide early diagnosis and aggressive interventions at the most proximal point of disease presentation.
- A common feature in these conditions is the implementation of early intervention strategies.
- One decade ago, a similar approach to sepsis began when a prospective randomized trial compared early goal–directed therapy (EGDT) to standard care using specific criteria for the early identification of high risk patients with infection.
- The components of EGDT were derived from expert consensus opinion to produce a protocol to reverse the hemodynamic perturbations of hypovolemia, vasodysregulation, myocardial suppression and increased metabolic demands for patients with severe sepsis in the intensive care unit (ICU).
- However, EGDT was provided at the most proximal phase of disease presentation in the Emergency Department (ED).
- With EGDT, a reduction in mortality of over 16% was shown over standard care.
- Since the EGDT study was published a decade ago, significant emphasis worldwide has been placed on a comprehensive approach to the first 6hours of sepsis management which is commonly referred to as the resuscitation bundle (RB).
- The RB consists of early diagnosis, risk stratification using lactate levels, hemodynamic response after a fluid challenge, antibiotics, source control and hemodynamic optimization or EGDT.