A multicentre study on early goal-directed therapy of severe sepsis and septic shock patients in the ICU: collaborative study group on early goal-directed therapy in Zhejiang Province, China

Abstract

The use of early goal-directed therapy (EGDT) in severe sepsis and septic shock has been shown to decrease morbidity and mortality rates significantly when given to patients prior to ICU admission, especially in the emergency department (ED). The aim of this study was to assess the efficacy of EGDT in severe sepsis and septic shock patients in the ICU. Methods A muticentre, prospective, randomized and controlled study. We randomly assigned patients admitted to the ICU with severe sepsis or septic shock to receive either 6 hours of EGDT or standard therapy (as a control). The primary end point (28-day mortality for any cause) and secondary end points (ICU stay days, mechanical ventilation duration, APACHE II scores and MODS scores) were obtained serially for 28 days and compared between the two groups. Results Of the 313 enrolled patients, 162 were randomly assigned to EGDT and 151 to standard therapy; there were no significant differences between the groups with respect to baseline characteristics. The 28-day mortality was 24.8% in the group assigned to EGDT, as compared with 42.5% in the group assigned to standard therapy (P = 0.001). During the interval from the first hour to 28 days stay in the ICU, the patients assigned to EGDT had a significantly lower APACHE II score (14.44 � 8.46 vs 18.00 � 7.04, P = 0.043) and MODS score (4.53 � 3.55 vs 7.09 � 4.95, P = 0.009) than those assigned to standard therapy; there were no differences in ICU stay days (20.6 � 1.9 vs 19.9 � 2.2, P = 0.82) and mechanical ventilation duration (13.2 � 1.5 vs 14.4 � 1.6, P = 0.6) between the two groups. Conclusions EGDT provides significant benefits with respect to outcome and scores in patients with severe sepsis and septic shock in the ICU. [28th International Symposium on Intensive Care and Emergency Medicine; Brussels, Belgium, 18-21 March 2008]