Early goal-directed therapy in sepsis: is it time for a new algorithm?

In 2001, Rivers and colleagues published the results of a randomised clinical trial, where a protocol for early therapy guided by clinical and haemodynamic goals in patients with septic shock demonstrated a reduction in mortality compared to usual care. This protocol includes the insertion of a central venous catheter for continuous measurement of central venous pressure and venous oxygen saturation, and the administration of red blood cells for patients with central venous oxygen saturation below 70%. These findings could not be reproduced by other studies, thus, Rivers strategy has been debated over the last few years. In this article, current evidence of early goal-directed therapy is reviewed, and an algorithm for initial management of septic shock, consistent with published studies is proposed.