TY - JOUR
T1 - A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators
AU - Angus, D.C.
AU - Barnato, A.E.
AU - Bell, D.
AU - Bellomo, R.
AU - Chong, C.R.
AU - Coats, T.J.
AU - Davies, A.
AU - Delaney, A.
AU - Harrison, D.A.
AU - Holdgate, A.
AU - Howe, B.
AU - Huang, D.T.
AU - Iwashyna, T.
AU - Kellum, J.A.
AU - Peake, S.L.
AU - Pike, F.
AU - Reade, M.C.
AU - Rowan, K.M.
AU - Singer, M.
AU - Webb, Steve
AU - Weissfeld, L.A.
AU - Yealy, D.M.
AU - Young, J.D.
PY - 2015
Y1 - 2015
N2 - © 2015, Springer-Verlag Berlin Heidelberg and ESICM. 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.
AB - © 2015, Springer-Verlag Berlin Heidelberg and ESICM. 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.
U2 - 10.1007/s00134-015-3822-1
DO - 10.1007/s00134-015-3822-1
M3 - Article
SN - 0342-4642
VL - 41
SP - 1549
EP - 1560
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 9
ER -