Is Early Goal-Directed Therapy Harmful to Patients With Sepsis and High Disease Severity?

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A protocol for resuscitation known as “early goal-directed therapy” (EGDT) has been promulgated since 2001 when Rivers et al (1) showed survival benefits in patients with severe sepsis and septic shock. Many observational and quasi-experimental studies have found similar results. Recently, three large randomized trials could not confirm a survival advantage using this approach. A just-published individual patient data meta-analysis performed as a collaboration among the authors of the three randomized trials confirmed that EGDT did not result in better outcomes compared with usual care (2).

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