Refining the tools for early goal-directed therapy in septic shock

Abstract

The cornerstone of septic shock treatment is initial therapy in the first hours to the extent that part of the therapy, response to fluid loading, is a diagnostic criterion for septic shock. Furthermore, owing to the lack of specificity of key clinical features in the classification of hypotension, diagnosis and treatment should be considered simultaneously since a good response to treatment confirms the working diagnosis. Immediate management includes ensuring oxygen supply, fluid therapy, assessment of the need for vasopressor or inotrope therapy, and specific treatments to control and treat the source of infection. In life-threatening situations, empirical treatment should not be delayed while monitoring devices are being inserted. Basic cardiorespiratory monitoring includes measurement of heart rate and blood pressure, and pulse oximetry. However, the new millenium has witnessed the emergence of a new paradigm in the resuscitation of septic shock: Early goal-directed therapy. Early goal-directed therapy is a therapeutic strategy integrating all the standard aspects of septic shock treatment such as fluid loading, vasopressor and inotrope use among others, into an algorithmic process in which each component has specific targets, and all are targeted to restored tissue perfusion. This strategy in itself has proved more successful in reducing mortality due to septic shock than any single pharmacologic treatment specifically targeting sepsis. However, there may be room for refining the steps, specific endpoints, and goals used in early goal-directed therapy in order to further reduce mortality in septic shock. © 2009 Springer-Verlag New York.