Between 2013 and 2015, three international trials found no mortality difference between EGDT and usual care, with usual care including early identification, early lactate measurement, early antibiotic administration (median: 1–3 hours from identification), and early fluid administration (median: 2–3 L).5-7 In pinpointing reasonable causes for the mortality differences between the Rivers trial and these three international trials that showed no dfference, Nguyen et al identified evolving practice over the ensuing 15 years, the baseline central venous oxygen saturation (ScvO2) >70 percent in all three trials, and the potential of a subset of this patient population who could benefit from normalizing an abnormally low ScvO2.8
It is interesting that four randomized, controlled trials encompassing defining points of two decades are scientifically in opposition but philosophically in alignment. They all required the breakdown of long-held barriers and promoting intentional collaboration across levels of care, locations of care, and service lines.
“The reality is that patients presenting with sepsis are admitted to the intensive care unit via the emergency department, general medical or surgical floors, operating rooms, and inter-hospital transport managed by a broad spectrum of specialties and care providers. As patients travel this landscape, current evidence suggests that the diagnostic and therapeutic expertise provided at each venue significantly impacts morbidity and mortality.”