Guidelines for Resuscitation of Sepsis

Early Goals-Directed Therapy

(EGDT)

KULIAH AKNES
1. Initial Resuscitation

 Resuscitation should begin as soon as severe

sepsis or sepsis induced tissue hypoperfusion is
recognized
 Elevated Serum lactate identifies tissue
hypoperfusion in patients at risk who are not
hypotensive
Early Goal-Directed Therapy Results
28-day Mortality
60
49.2%
50 P = 0.01*

40
33.3%
30

20

10

0
Standard Therapy EGDT
n=133 n=130
*Key difference was in sudden CV collapse, not MODS
Goals of therapy within first 6 hours are
Recommendation : Grade B
1. Central Venous Pressure 8-12 mm Hg (12-15 in ventilator
pts)
2. Mean arterial pressure > 65 mm Hg
3. Urine output > 0.5 mL/kg/hr
4. ScvO2 or SvO2 ≥ 70%;

5. if not achieved with fluid resuscitation during first 6

hours:
- Transfuse PRBC to hematocrit > 30% and/or
- Administer dobutamine (max 20 mcg/kg/min) to goal
Study design
SIRS criteria
SBP < 90 mmHg
Lactate > 4 mmol/L

Assessment and consent

Standard Therapy Randomization (n=263) Early goal-directed

in ED (n=130) therapy (n=133)

Vital sign, Lab data, cardiac

monitoring, pulse oximetry,
Urinary catheterization,
arterial and venous CVP 8-12 mmHg
CVP 8-12 mmHg catheterization
MAP ≥ 65 mmHg
MAP ≥ 65 mmHg Standard care Continuous SvO2
monitoring and Urine ≥ 0.5 cc/kg/min
EGDT for 6 hours
Urine ≥ 0.5
cc/kg/min ScvO2 ≥ 70%
Hospital admission

SaO2 ≥ 93%

Vital sign, lab data, Hematocrit ≥ 30%

obtained every 12 hour
for 72 hour
Cardiac index

Did not complete Did not complete VO2

6 hour (n=14) Follow up 6 hour (n=13)
Mudah-mudahan bermanfaat untuk :

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