Early Goal-Directed Therapy With and Without Intermittent Superior Vena Cava Oxygen Saturation Monitoring in Pediatric Septic Shock: A Randomized Controlled Trial

2021 ◽  
Vol 58 (12) ◽  
pp. 1124-1130
Author(s):  
Puneet Jain ◽  
Ramachandran Rameshkumar ◽  
Ponnarmeni Satheesh ◽  
Subramanian Mahadevan
Keyword(s):  
Septic Shock ◽  
Randomized Controlled Trial ◽  
Oxygen Saturation ◽  
Superior Vena Cava ◽  
Controlled Trial ◽  
Superior Vena ◽  
Vena Cava ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Randomized Controlled

scholarly journals Early goal-directed therapy using a physiological holistic view: the ANDROMEDA-SHOCK—a randomized controlled trial

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Glenn Hernández ◽  
◽  
Alexandre Biasi Cavalcanti ◽  
Gustavo Ospina-Tascón ◽  
Fernando Godinho Zampieri ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Holistic View ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Randomized Controlled

VENOUS OXYGEN SATURATION AND LACTATE GRADIENT FROM SUPERIOR VENA CAVA TO PULMONARY ARTERY IN PATIENTS WITH SEPTIC SHOCK

Shock ◽  
2009 ◽  
Vol 31 (6) ◽  
pp. 562-568 ◽  
Author(s):  
Petros Kopterides ◽  
Stefanos Bonovas ◽  
Irini Mavrou ◽  
Eleni Kostadima ◽  
Epaminondas Zakynthinos ◽  
...  
Keyword(s):  
Septic Shock ◽  
Pulmonary Artery ◽  
Oxygen Saturation ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Oxygen Saturation

scholarly journals Echocardiography-Guided Hemodynamic Management of Severe Sepsis and Septic Shock in Adults: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Walid S. Alhabashy ◽  
Osama M. Shalaby ◽  
Ahmed S. Elgebaly ◽  
Mohammed S. Abd El Ghafar
Keyword(s):  
Septic Shock ◽  
Randomized Controlled Trial ◽  
Severe Sepsis ◽  
Controlled Trial ◽  
Total Fluid Intake ◽  
Early Goal Directed Therapy ◽  
Randomized Controlled ◽  
Group I ◽  
Hospital Stays ◽  
Sepsis And Septic Shock

Abstract Background: Echocardiography (ECHO) is used to guide septic shock resuscitation, but without evidence for efficacy. Therefore, we compared the outcome of early goal-directed therapy (EGDT) and ECHO-guided management of hemodynamics in severe sepsis and septic shock. Materials and Methods: This is a single center, randomized controlled trial conducted on 100 adult patients with severe sepsis or septic shock. Patients were assessed and treated with either EGDT protocol (EGDT group) or ECHO-guided resuscitation protocol (ECHO group). Results: Only 87 patients (45 in group I and 42 in group II) were analyzed. There was a significant increase of mean norepinephrine and dobutamine doses and a significant decrease in total fluids in the first 24 hours, time to normalization, time to weaning of vasopressors, total MV days, MV free days and ICU and hospital stays in ECHO group. At 30 days, the mortality rate in EGDT group was 35.6% which was significantly higher compared to 14.3% in ECHO group. At 90 days, the overall mortality was significantly higher in EGDT group compared to Echo group (40.0% vs 16.7% respectively). Hazardous ratio of mortality was 1.630 (95% confidence interval (CI): 1.123 - 2.366) and 1.653 (95% CI: 1.137 - 2.404) at 30 and 90 days respectively in EGDT group compared to ECHO group. Conclusions: In severe sepsis and septic shock, ECHO-guided management of hemodynamics resulted in a decrease in mortality, lower total fluid intake, higher vasopressor and inotrope support, earlier weaning of vasopressors and less MV days, ICU and hospital stay.

scholarly journals Venous oxygen saturation and lactate gradient from the superior vena cava to the pulmonary artery in ICU patients with septic shock

Critical Care ◽  
2009 ◽  
Vol 13 (Suppl 1) ◽  
pp. P235
Author(s):  
P Kopterides ◽  
I Mavrou ◽  
E Kostadima ◽  
E Zakynthinos ◽  
M Lignos ◽  
...  
Keyword(s):  
Septic Shock ◽  
Pulmonary Artery ◽  
Oxygen Saturation ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Icu Patients ◽  
Venous Oxygen Saturation

The Physiology of Early Goal-Directed Therapy for Sepsis

2016 ◽  
Vol 32 (10) ◽  
pp. 567-573
Author(s):  
Lindsay Lief ◽  
John Arbo ◽  
David A. Berlin
Keyword(s):  
Clinical Trials ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Therapeutic Interventions ◽  
Aggressive Treatment ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Randomized Controlled

In 2001, Rivers and colleagues published a randomized controlled trial of early goal-directed therapy (EGDT) for the treatment of sepsis. More than a decade later, it remains a landmark achievement. The study proved the benefits of early aggressive treatment of sepsis. However, many questions remain about specific aspects of the complex EGDT algorithm. Recently, 3 large trials attempted to replicate these results. None of the studies demonstrated a benefit of an EGDT protocol for sepsis. This review explores the physiologic basis of goal-directed therapy, including the hemodynamic targets and the therapeutic interventions. An understanding of the physiologic basis of EGDT helps reconcile the results of the clinical trials.

scholarly journals Echocardiography-Guided Hemodynamic Management of Severe Sepsis and Septic Shock in Adults: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Walid S. Alhabashy ◽  
Osama M. Shalaby ◽  
Ahmed S. Elgebaly ◽  
Mohammed S. Abd El Ghafar
Keyword(s):  
Septic Shock ◽  
Randomized Controlled Trial ◽  
Severe Sepsis ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Total Fluid Intake ◽  
Early Goal Directed Therapy ◽  
Randomized Controlled ◽  
Group I ◽  
Sepsis And Septic Shock

Abstract Background: Echocardiography (ECHO) is used to guide septic shock resuscitation, but without evidence for efficacy. Therefore, we compared the outcome of early goal-directed therapy (EGDT) and ECHO-guided management of hemodynamics in severe sepsis and septic shock. Methods: This is a single canter, randomized controlled trial conducted on 100 adult patients with severe sepsis or septic shock. Patients were assessed and treated either EGDT protocol (EGDT group) or ECHO-guided resuscitation protocol (ECHO group). Results: In this study, only 87 patients with severe sepsis/septic shock were analyzed; 45 patients in group I and 42 patients in group II. There was significant increase of norepinephrine, dobutamine doses, MV free days, time to normalization, time to weaning of vasopressors, total MV days and ICU and hospital stay in EGDT group compared to ECHO group. At 30 days, the mortality rate in EGDT group was 35.6% which was significantly higher compared to 14.3% in ECHO group. At 90 days, the overall mortality was significantly higher in EGDT group compared to Echo group (40.0% vs 16.7% respectively). Hazardous ratio of mortality was 1.630 (95% confidence interval (CI): 1.123 - 2.366) and 1.653 (95% CI: 1.137 - 2.404) at 30 and 90 days respectively in EGDT group compared to ECHO group.Conclusion: In severe sepsis and septic shock, ECHO-guided management of hemodynamic resulted in decrease in mortality, lower total fluid intake, vasopressor and inotrope, earlier weaning of vasopressors and less MV days, ICU and hospital stay.

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