A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2015-09

AUTHORS

D. C. Angus, A. E. Barnato, D. Bell, R. Bellomo, C.-R. Chong, T. J. Coats, A. Davies, A. Delaney, D. A. Harrison, A. Holdgate, B. Howe, D. T. Huang, T. Iwashyna, J. A. Kellum, S. L. Peake, F. Pike, M. C. Reade, K. M. Rowan, M. Singer, S. A. R. Webb, L. A. Weissfeld, D. M. Yealy, J. D. Young

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 [I(2) = 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 (I(2) = 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 (I(2) = 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. More... »

PAGES

1549-1560

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00134-015-3822-1

DOI

http://dx.doi.org/10.1007/s00134-015-3822-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1031864059

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25952825


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