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Editorials: POINT/COUNTERPOINT EDITORIALS |

Point: Adherence to Early Goal-Directed Therapy: Does It Really Matter? Yes. After a Decade, the Scientific Proof Speaks for Itself

Emanuel P. Rivers, MD, FCCP
Author and Funding Information

From the Departments of Emergency and Surgery (Critical Care), Henry Ford Hospital, and Wayne State University.

Correspondence to: Emanuel P. Rivers, MD, FCCP, Henry Ford Hospital, 2799 W Grand Blvd, CFP-270, Detroit, MI, 48202-2608; e-mail: erivers1@hfhs.org


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Rivers receives research funding from the National Institutes of Health and has been a one-time consultant to Aggennix, AstraZeneca, Esai Pharmaceuticals, and has consulted for Idaho Technologies for the past 2 years.

Editor’s Note: In the Point/Counterpoint debate that follows, Drs Rivers and Schmidt address the question of whether early goal-directed therapy really matters. In doing so, they also provide editorial comment on an article published in this issue that describes factors associated with nonadherence with early goal-directed therapy in an ED.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):476-480. doi:10.1378/chest.10-1405
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Extract

The study by Mikkelsen et al1 in this issue of CHEST (see page 551) is an important and yet troubling observation at one of the premier medical centers in the United States. This study reveals that adherence to a therapy for a disease with a mortality rate of 30% to 50% and the cause of > 215,000 deaths per year nationally is initiated in only 42% of eligible patients. If a similar nonadherence to therapies for other acute diseases such as stroke, trauma, or acute myocardial infarction was observed, would it be acceptable? Why does this paradigm continue to exist for severe sepsis and septic shock?

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