Capillary Refill Time in Sepsis

Almost 25 years ago, a landmark trial of early goal-directed therapy (EGDT) by Rivers and colleagues reshaped the care of septic shock by introducing the concept that “early” management was crucial. Although implementation has varied across high- and low-resource settings, the importance of early sepsis recognition and treatment is now nearly universally accepted. In contrast, the specific manner by which goal-directed therapy for septic shock should be provided remains highly controversial. Conceptually, goal-directed therapy is a resuscitation protocol involving a goal to be achieved, serial assessments of the patient’s physiologic status, and administration of therapies that the assessments indicate will help achieve the goal. But what are the right goals, assessments, and therapies to improve outcomes for patients with early sepsis?