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But they Weren't Sick Enough…
SSC Reverses their Stance on EGDT (Sort of…)
What do folks thing EGDT still brings to the table?
Cognitive DeBiasing
Please ask yourself, before you air your viewpoints in public, are you displaying Confirmation Bias
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Editor-in-Chief, EMCrit.org at EDECMO LLC
An ED Intensivist from NY. No conflicts of interest (coi).
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It seems to me that EGDT still provides the framework for an easily implemented protocol in institutions that have greater than average sepsis mortality. Since we still are not clear on which part of “intuitive care” is truly bending the curve for these patients, is there harm in using it as a guideline? Correct me if I am wrong but it seems the average treatment for septic patients varies little (i.e. the 170 ml difference you cite between “liberal” and “judicious” fluid administration) in the studied groups with similar outcomes and in your ARISE podcast you state that it may… Read more »
Costs + harms are all that are left when there is no benefit. More vasopressors, more blood, more fluid = more opportunity for harm with each treatment. Not to suggest that these things do not have benefit, but when protocolized they are used more than needed.
Greg if you need a regimented protocol, use the hybrid protocol from ProCESS–all the good, none of the bad.
Dr Rivers is one of my all time heroes for many reasons. For me as an emergency physician he made me realize that I needed to be good a critical care, be scientific in my approach to sick patients and care about sepsis. Without his genius we would not be able to have this debate. All these studies stand on his shoulders. If I could give this guy hug, and buy him a pint I would! But things have moved on, as they do in medicine, which is one of the most exciting and also frustrating parts of EM! What… Read more »
ahh James, where have you been. I just started a new job and need some logistics episodes. contact me if interested!
agree with all of the above
Hi Scott,
Yes I’m interested and just emailed you,
hope all is well with you and at your new department,
JF
I see this whole thing as a bit of an artificial argument. First of all, most of us who aren’t literalists or have some financial stake in the game never bought into the precise details of EGDT in the first place. To paraphrase what Pinsky said at SCCM a few years ago, ‘the purpose of EDGT was to give non-intensivists a framework for taking care of septic patients in the middle of the night’. Do I give blood? Sometimes, not often. SvO2? Usually not. Central line? Usually. Etc. Just as most of us never believed that it was imperative to… Read more »