Part 1 of the history of sepsis appeared in the November issue.
Prior to 2000, there was no universal sense of urgency for treating septic patients. Care was generally fractured, with little collaboration among the pre-hospital service, emergency department, intensive care unit, and wards. Universal use of ultrasound in emergency departments or intensive care units (ICUs) was non-existent during this period, although global myocardial dysfunction from sepsis was an emerging concept.
In 2001, Rivers et al reported results of a new protocolized resuscitation termed early goal-directed therapy (EGDT).1 EGDT was described as a structured treatment protocol that incorporated elements consistent with the 1992 consensus guidelines focusing on preload, afterload, contractility, and oxygen delivery.2 The absolute mortality benefit of 16 percent (46.5 to 30.5 percent) represented one of the most effective modalities to date. Over the ensuing 12 years, multiple observational studies supported a mortality benefit of varying degrees.3 EGDT was included in the first three iterations of the Surviving Sepsis Campaign (SSC) guidelines and was a central component of emergency medicine–specific guidelines.4