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Evevident
Original paper
2001NEJMPulmonary/Critical Care

Rivers EGDT

Early goal-directed therapy in the treatment of severe sepsis and septic shock

RCTSepsis

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Overview

Single-center early goal-directed therapy reduced mortality in severe sepsis/septic shock versus then-usual care.

Clinical takeaway

Rivers EGDT catalyzed protocolized sepsis resuscitation, but later trials showed the specific invasive EGDT bundle was not necessary once early antibiotics, fluids, and source control became routine.

Key result

In-hospital mortality was 30.5% with EGDT vs 46.5% with standard therapy.

Practice impact

Made early sepsis recognition and aggressive early resuscitation central to care.

Evidence

Study design

Single-center randomized controlled trial.

Enrollment

263

Follow-up

In-hospital; mortality also reported at 28 and 60 days.

Geography

United States

Clinical question

Does protocolized EGDT improve outcomes in severe sepsis or septic shock?

Population

  • Emergency-department patients with severe sepsis or septic shock.

Intervention

Protocolized early goal-directed therapy targeting CVP, MAP, urine output, and central venous oxygen saturation (ScvO2) over the first 6 hours.

Comparator

Standard therapy at the time.

Primary outcome

In-hospital mortality.

Protocolized early goal-directed therapy reduced in-hospital mortality from 46.5% to 30.5% versus then-standard care at a single center.

Absolute mortality reduction / 16 / p=0.009

Key results

  • In-hospital mortality: 30.5% with EGDT vs 46.5% with standard therapy (relative risk 0.58; p=0.009).
  • 28-day (33.3% vs 49.2%) and 60-day mortality were also lower with EGDT.
  • During the first 6 hours the EGDT group received more fluids, more transfusions, and more dobutamine.

Harms

  • EGDT involved central venous catheterization and more red-cell transfusion and inotrope use, with attendant risks.
  • Later multicenter trials (ProCESS, ARISE, ProMISe) found no mortality benefit from the full invasive protocol once early antibiotics and fluids were routine.

Clinical Use

When to cite

  • When teaching the historical shift toward early sepsis recognition and resuscitation, while noting central-line EGDT targets are no longer mandatory.

Practice impact

  • Made early sepsis recognition and aggressive early resuscitation central to care.

Applicability

  • Most applicable to emergency-department patients with severe sepsis or septic shock; the enduring lesson is early recognition and resuscitation.

Limitations

  • Single-center study with a strikingly high control-group mortality.
  • Control care predates modern sepsis practice (early antibiotics, lactate-guided fluids).
  • Later multicenter trials did not replicate a need for the full invasive EGDT protocol.

Common misinterpretations

  • The specific CVP/ScvO2-targeted bundle is not required; ProCESS, ARISE, and ProMISe showed usual early care works as well.
  • Rivers established the value of early aggressive resuscitation, not the necessity of central-line-based protocols.

Related evidence

ProCESS - Later Trial

Citation

Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377. doi:10.1056/NEJMoa010307

Early goal-directed therapy provides significant benefits with respect to outcome in patients with severe sepsis and septic shock.