Toward a Noninvasive Approach to Early Goal-Directed Therapy

Although early goal-directed therapy (EGDT) has been a landmark in guiding the approach to patients with sepsis in the ED, few institutions seem willing and able to adopt it for all eligible patients. 1 The complexity and invasiveness of the protocol are the most frequently cited barriers. In particular, it has been underlined that many clinicians would not feel comfortable with inserting a central venous catheter (CVC) as a guide to treatment when, for various reasons, they believe that their patients could be treated adequately with a noninvasive approach. In his counterpoint editorial in a recent issue of CHEST (September 2010), Schmidt 2 maintained that the development lymphoma. Further investigations are needed to clarify whether there is antineoplastic activity in clarithromycin.