Bilan de l'early goal-directed therapy, neuf ans après

The Rivers' Early Goal-Directed Therapy (EGDT) has become the central part of recommendations in the field of severe sepsis hemodynamic resuscitation. Its pivotal features are: quick insertion of central venous and arterial lines, prompt and abundant volume resuscitation guided by central venous pressure (CVP), a mean arterial pressure of 65 mmHg as therapeutic target, and frequent (every 30 minutes) monitoring of central venous oxygen saturation (ScvO2) during the initial phase. Numerous medical teams have reported their first experience with the implementation of such a protocol, in terms of staff adhesion to guidelines and in terms of patients' outcomes. The value of the initial and abundant fluid loading is now recognized. Other parts of the EGDT protocol are anecdotally adopted: particularly, the choice of the CVP as a guide for fluid administration, and the rapid attempt at ScvO2 normalization as a valid concept, as compared to other clinically or biologically-based strategies might deserve additional controlled trials.