Abstract
Background: Echocardiography (ECHO) is used to guide septic shock resuscitation, but without evidence for efficacy. Therefore, we compared the outcome of early goal-directed therapy (EGDT) and ECHO-guided management of hemodynamics in severe sepsis and septic shock.
 Methodology: This was a single center, randomized controlled trial conducted on 100 adult patients with severe sepsis or septic shock. Patients were assessed and treated with either EGDT protocol (Group I - EGDT group) or ECHO-guided resuscitation protocol (Group II - ECHO group). 
 Results: Only 87 patients (45 in Group I and 42 in Group II) were analyzed. There was a significant increase of mean norepinephrine and dobutamine use and a significant decrease in total fluids needed in the first 24 h, time to normalization, time to weaning of vasopressors, total mechanical ventilation (MV) days, MV free days and ICU and hospital stay in ECHO group. At 30 days, the mortality rate in EGDT group was 35.6% which was significantly higher compared to 14.3% in the ECHO group. At 90 days, the overall mortality was significantly higher in EGDT group compared to ECHO group (40.0% vs 16.7% respectively). Hazardous ratio of mortality was 1.630 [95% confidence interval (CI): 1.123 - 2.366] and 1.653 (95% CI: 1.137 - 2.404) at 30 and 90 days respectively in EGDT group compared to ECHO group.
 Conclusions: In severe sepsis and septic shock, ECHO-guided management of hemodynamics resulted in a decrease in mortality, lower total fluid intake, higher vasopressor and inotrope support, earlier weaning of vasopressors; and reduced mechanical ventilation days, as well as ICU and hospital stay.
 Keywords: Echocardiography; EGDT; Severe sepsis; Septic Shock; Adults
 Citation: Alhabashy WS, Shalaby OM, Elgebaly AS, Abd El Ghafar MS. Echocardiography-guided hemodynamic management of severe sepsis and septic shock in adults: a randomized controlled trial. Anaesth. pain intensive care 2021;25(6):722–732;
 DOI: 10.35975/apic.v25i6.1694
 Received: June 20, 2021, Reviewed: August 10, 2021, Accepted: August 13, 2021
Highlights
Severe sepsis and septic shock are common in critically ill patients and are on top of the causes of mortality in intensive care units (ICU).[1]
There was a significant increase of mean norepinephrine and dobutamine use and a significant decrease in total fluids needed in the first 24 h, time to normalization, time to weaning of vasopressors, total mechanical ventilation (MV) days, MV free days and ICU and hospital stay in ECHO group
Hazardous ratio of mortality was 1.630 [95% confidence interval (CI): 1.123 - 2.366] and 1.653 at 30 and 90 days respectively in early goal-directed therapy (EGDT) group compared to ECHO group
Summary
Severe sepsis and septic shock are common in critically ill patients and are on top of the causes of mortality in intensive care units (ICU).[1]. 2. A paradigm of “early goal-directed therapy” (EGDT) has been dominated in sepsis resuscitation for about fifteen years, based on the results of a single-center, 722 www.apicareonline.com echocardiography in severe sepsis & septic shock. The invasive assessment of hemodynamic parameters using central venous catheters and/or pulmonary artery catheters allowed clinicians to define cardiovascular physiology and dominated fluid management for many years. 9 the use of such techniques has significantly been decreased due to risks associated with their use Their “static” variable outcomes poorly predicted fluid responsiveness, and prospective studies showed no benefit from their routine use. We compared the outcome of early goal-directed therapy (EGDT) and ECHO-guided management of hemodynamics in severe sepsis and septic shock
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