Early Goal-Directed Therapy: The History and Ongoing Impact on Management of Severe Sepsis and Septic Shock.

The use of early goal-directed therapy (EGDT) for the management of severe sepsis and septic shock, a practice put forth by Dr. Rivers et al. in 2001, ushered in a new era of targeted sepsis therapy. After its publication, several further studies helped validate the protocolized approach to sepsis management, ultimately leading to its incorporation into the Surviving Sepsis Campaign guidelines. Since that time, however, a trio of large multi-center randomized controlled trials have taken place to evaluate the efficacy of EGDT when compared with usual care and have demonstrated that strict adherence to the entirety of the original EGDT protocol is unnecessary for improved outcomes. Some recommendations, such as higher goal hemoglobin and hematocrit levels and liberal crystalloid fluid resuscitation, are likely harmful. Despite controversy over a number of the recommendations, early identification of sepsis, source control, and prompt empiric antibiotic administration remain the mainstay of treatment for patients with sepsis and septic shock.