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