Friday, April 07, 2006

EGDT and need for PAC

Saturday April 8, 2006
Early Goal-Directed Therapy and Pulmonary Artery Catheter need

Various institutions are running protocols and study in reference to Early Goal-Directed Therapy and we are learning new aspects related to this approach. Recent study from Cooper University Hospital, Camden, NJ (done by Trzeciak, Dellinger, Parillo and Colleauges), found 2 lessons:

1. Emergency medicine and Critical Care collaboration can be run effectively and all end points of EGDT were successfully achieved for 20 of 22 EGDT cases. End points were CVP, MAP and ScvO2.It proved that EGDT can reliably be achieved in "real-world clinical practice". The following median times were observed:

  • central line insertion, 1.5 hours;
  • CVP goal, 6.0 hours;
  • MAP goal, 4.0 hours;
  • ScvO2 measured, 2.0 hours; and
  • ScvO2 goal, 5.0 hours

2. Another interesting outcome of study was Pulmonary Artery Catheter utilization in the ICU was significantly lower with EGDT (9.1%) vs pre-EGDT (43.8%) [p = 0.01].

Related Previous Pearl:

Shock alert - Shock bed

A 1-Year Experience With Implementing Early Goal-Directed Therapy for Septic Shock in the Emergency Department - Translating Research to Clinical Practice - Chest. 2006;129:225-232