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Type: Journal article
Title: A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators
Author: Angus, D.
Barnato, A.
Bell, D.
Bellomo, R.
Chong, C.
Coats, T.
Davies, A.
Delaney, A.
Harrison, D.
Holdgate, A.
Howe, B.
Huang, D.
Iwashyna, T.
Kellum, J.
Peake, S.
Pike, F.
Reade, M.
Rowan, K.
Singer, M.
Webb, S.
et al.
Citation: Intensive Care Medicine, 2015; 41(9):1549-1560
Publisher: Springer
Issue Date: 2015
ISSN: 0342-4642
Statement of
D. C. Angus ... C.-R. Chong ... S. L. Peake ... et al.
Abstract: Purpose: To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock. Methods: Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay. Results: From 2395 initially eligible abstracts, five randomised clinical trials (n = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2 % [495/2134] versus control: 22.4 % [582/2601]; pooled OR 1.01 [95 % CI 0.88–1.16], P = 0.9, with heterogeneity [I2 = 57 %; P = 0.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n = 4063) also showed no difference [pooled OR 0.99 (95 % CI 0.86–1.15), P = 0.93] with no heterogeneity (I2 = 0.0 %; P = 0.97). EGDT increased vasopressor use (OR 1.25 [95 % CI 1.10–1.41]; P < 0.001) and ICU admission [OR 2.19 (95 % CI 1.82–2.65); P < 0.001]. Including six non-ED randomised trials increased heterogeneity (I2 = 71 %; P < 0.001) but did not change overall results [pooled OR 0.94 (95 % CI 0.82 to 1.07); P = 0.33]. Conclusion: EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.
Keywords: Early goal-directed therapy or EGDT; resuscitation; septic shock; central venous oxygen saturation; meta-analysis; systematic review; randomised clinical trials
Rights: © Springer-Verlag Berlin Heidelberg and ESICM 2015
DOI: 10.1007/s00134-015-3822-1
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