What is early goal directed therapy?
Early, goal-directed therapy is a management scheme that has been most strongly promoted for children with septic shock. This therapy is an aggressive approach to improve physiologic indicators of perfusion and vital organ function in the first 6 hours. Physiologic indicators targeted during early, goal-directed therapy include the following:
- 1. Blood pressure (systolic pressure minimally 60 mm Hg for those <1 month of age, 70 mm Hg + [2 × age in years] in children 1 month to 10 years of age, 90 mm Hg in children 10 years of age or older)
- 2. Strong, distal pulses equal to central pulses
- 3. Skin perfusion (warm, with capillary refill < 2 seconds)
- 4. Normal mental status
- 5. Urine output (≥ 1 mL/kg/hour, once effective circulating volume is restored)
Brierley J, Carcillo JA, Choong K, et al: Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 2009;37(2):666-688.
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;345:1368-1377.