Early Goal Directed Therapy was introduced by Emanuel P. Rivers, MD, MPH in the New England Journal of Medicine in 2001 and is a technique used in critical care medicine involving intensive monitoring and aggressive management of perioperative hemodynamics in patients with a high risk of morbidy and mortality.[1] In cardiac surgery, GDT has proved effective when commenced after surgery. The combination of goal-directed therapy and Point-of-Care Testing has demonstrated a marked decrease in mortality for patients undergoing congenital heart surgery.[2] Further more, a reduction in morbidity and mortality has been associated with GDT techniques when used in conjunction with an electronic medical record.[3]
Early Goal-Directed Therapy is a more specific form of therapy used for the treatment of severe sepsis and septic shock. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with an increased oxygen demand before surgery.[4]
In the event of hypotension and/or lactate > 4 mmol/L, then deliver an initial minimum of 20 ml/kg of crystalloid (or colloid equivalent).
Apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure (MAP) > 65 mm Hg.
In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate > 4 mmol/L (36 mg/dl):
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