Evolution of Sepsis Management in the Emergency Department: From Early Goal-Directed Therapy to Personalized Resuscitation

Sepsis remains a leading cause of morbidity and mortality worldwide and represents a major challenge in emergency medicine. Early recognition and timely intervention are critical determinants of patient outcomes. The introduction of early goal-directed therapy (EGDT) in 2001 transformed sepsis management by promoting protocolized hemodynamic resuscitation during the initial hours of care. However, subsequent evidence challenged the routine use of invasive EGDT targets and led to significant changes in contemporary sepsis management strategies. This narrative review examines the evolution of sepsis management in the emergency department, focusing on the development, implementation, and reassessment of EGDT. Literature published between 2001 and 2026 was reviewed using major medical databases and guideline repositories, with emphasis on landmark randomized controlled trials (RCTs), systematic reviews, meta-analyses, and international guideline statements. Key studies, including Protocolized Care for Early Septic Shock (ProCESS), Australasian Resuscitation in Sepsis Evaluation (ARISE), and Protocolised Management in Sepsis (ProMISe), demonstrated no mortality benefit of rigid protocolized EGDT compared with contemporary standard care, contributing to a shift toward individualized, physiology-guided resuscitation strategies. Current evidence supporting early antimicrobial administration, balanced crystalloid resuscitation, dynamic assessment of fluid responsiveness, early vasopressor initiation, and lactate-guided monitoring is reviewed, along with ongoing controversies involving antibiotic timing, fluid management, biomarker-guided therapy, and personalized sepsis care. Although protocolized EGDT is no longer routinely recommended, its emphasis on early recognition and prompt intervention continues to influence modern sepsis management. Contemporary practice favors individualized, patient-centered approaches focused on rapid diagnosis, timely antimicrobial therapy, targeted hemodynamic support, and continuous reassessment of tissue perfusion, while future advances are likely to involve biomarker-guided treatment, precision medicine, and artificial intelligence-assisted clinical decision support.