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Treating Septic Shock. (Clinical Capsules).

Goal-directed therapy provided early in the course of severe sepsis or septic shock had significant benefits over standard therapy in a recent study.

Of 263 patients who presented to the emergency department, 130 were randomly assigned to 6 hours of early goal-directed therapy-a resuscitation strategy including manipulation of cardiac preload, afterload, and contractility to restore a balance between oxygen delivery and demand and to prevent cardiac collapse. Another 133 patients were assigned to 6 hours of standard therapy in the emergency department prior to admission to the intensive care unit, reported Dr. Emanuel Rivers and his colleagues at Henry Ford Health Systems, Detroit.

The in-hospital mortality rate for the goal-directed therapy group was 30.5%, compared with 46.5% in the standard therapy group. Furthermore, during the 7-72 hours following the initial therapy those in the goal-directed therapy group had higher mean central venous oxygen saturation, lower lactate concentration, lower base deficit, higher pH, and significantly less severe organ dysfunction than those in the standard therapy group.

Also, those in the goal-directed therapy group had a significantly shorter hospital stay (14.6 days) than those in the standard therapy group (18.4 days), the investigators said (N. Engl. J. Med. 345[19]:1368-77, 2001).
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Author:Worcester, Sharon
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jan 1, 2002
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