Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/103259
Citations | ||
Scopus | Web of Science® | Altmetric |
---|---|---|
?
|
?
|
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 1432-1238 |
Statement of Responsibility: | 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 |
Appears in Collections: | Aurora harvest 3 Medicine publications |
Files in This Item:
There are no files associated with this item.
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.