Evaluation of a modified early goal-directed therapy protocol

Objectives: The study aimed to determine mortality in septic patients 2 years after introduction of a modified early goal-directed therapy (EGDT) protocol and to measure compliance with the protocol. Design: This was an observational study of prospectively identified patients treated with EGDT in our emergency department (ED) from May 2007 through May 2008 and compared with retrospectively obtained data on patients treated before protocol implementation, from May. 2004 to May 2005. Setting: This study was conducted at a large tertiary-care suburban community hospital with more than 85 000 ED visits annually and 700 inpatient beds. Patients: Patients with severe sepsis or septic shock were included in the study. Interventions: A modified EGDT protocol was implemented. Measurements and Main Results: A total of 216 patients were treated with our EGDT protocol, with 32.9% mortality (95% confidence interval [Cl], 26.6%-39.2%); 183 patients (84.7%) had septic shock, with a mortality of 34.4% (95% Cl, 28%-41%). Our control group of 205 patients had a 27.3% mortality (95% Cl, 21.2%-33.5%), of which 123 had septic shock with a mortality of 43.1% (95% Cl, 34%-52%). Early goal-directed therapy protocol compliance was as follows: 99% received adequate intravenous fluids, 99% had a central line, 98% had antibiotics in the first 6 hours, 28% had central oxygen saturation measured, 3.7% received dobutamine, and 19% were transfused blood. Conclusions: Although we found a trend toward decreased mortality in patients with septic shock treated with EGDT, with an absolute difference of 8.7%, this difference was not statistically significant. Compliance with individual elements of the protocol was variable. (C) 2010 Elsevier Inc. All rights reserved.