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Editorials: POINT/COUNTERPOINT EDITORIALS |

Rebuttal From Dr Rivers

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.

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):483-484. doi:10.1378/chest.10-1414
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Extract

Early goal-directed therapy (EGDT) is not only a life-saving intervention but also a systems-based approach similar to that used for acute myocardial infarction, stroke, and trauma. Instead of a similar universal adoption, debate continues with a myopic focus on its integrated components (which have been around for > 60 years), which have been addressed in a previously published rebuttal.1 Physical examination or gestalt does not accurately assess hemodynamic status.2 A low central venous oxygen saturation (Scvo2) of 28% to 73% in the ICU is not only common but also predictive of outcome.3 Antibiotics, an unquestionable therapy, can result in lethal complications and have never undergone a randomized multicenter trial. The bottom line is that EGDT decreases hospital length of stay, exposure to more interventions, and, thus, hospital-related complications.

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