Value of early goal-directed therapy for treatment of surgical patients with severe sepsis

doi:10.3321/j.issn:1005-2208.2009.12.015

Abstract：Objective To investigate the effect of early goal-directed therapy(EGDT)on surgical patient with severe sepsis.Methods One hundred and seventy-seven surgical patients with severe sepsis admitted between August 2004 and June 2007 at 7 hospitals of Grade Ⅲ Level A in Zhejiang Province were randomized to conventional treatment group (n=90)and EGDT group(n=87),the former was underwent fluid resuscitation goaled by central venous pressure(CVP),mean arlery blood pressure(MBP) or systolic blood pressure(SBP) and urinary output,and the latter was guiding byCVP,MBP or SBP and UO plus central venous oxygen saturation(ScvO_2);The patients were achieved the goals bytreating with fluid,transfusions and cardiac stimulants in a period of 6 hours after enrollment.The difference of 28-day survival(primary endpoint),the length of stay in ICU,mechanical ventilation time,antibiotics utilization time,complication of newlv infection and clinicai scores(secondary endpoints)between the 2 groups was compared.Results In comparison with conventional group,the 28-day survival of EGDT group was increased by 18%(79.3%vs 61.1%,P=0.023).the APACHE Ⅱ score and MODS score were significantly improved after 6h of EGDT fluid resuscitation(APACHE Ⅱ:21.7±5.9 vs 15.4±4.3,P=0.008;MODS:8.4±3.3 vs 5.1±2.9,P=0.017),there is no difference in other parameters for secondary endpoint(all P>0.05).Conclusion EGDT improved 28-day survival and clinical scores and had beneficial effects on outcomes in surgical patients with severe sepsis.