Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 1549 - 1560 |
| Number of pages | 12 |
| Journal | Intensive Care Medicine |
| Volume | 41 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 2015 |
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A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. / Angus, Derek C; Barnato, Amber; Bell, Derek; Bellomo, Rinaldo; Chong, Cherrin; Coats, Timothy J; Davies, Andrew Ross; Delaney, Anthony; Harrison, David A; Holdgate, Anna; Howe, Belinda Duval; Huang, David T; Iwashyna, Theodore John; Kellum, John A; Peake, Sandra Lois; Pike, Francis; Reade, Michael C; Rowan, Kathy; Singer, Mervyn; Webb, Steven A R; Weissfeld, Lisa A; Yealy, Donald M; Young, John Duncan.
In: Intensive Care Medicine, Vol. 41, No. 9, 2015, p. 1549 - 1560.Research output: Contribution to journal › Article › Research › peer-review
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, Derek C
AU - Barnato, Amber
AU - Bell, Derek
AU - Bellomo, Rinaldo
AU - Chong, Cherrin
AU - Coats, Timothy J
AU - Davies, Andrew Ross
AU - Delaney, Anthony
AU - Harrison, David A
AU - Holdgate, Anna
AU - Howe, Belinda Duval
AU - Huang, David T
AU - Iwashyna, Theodore John
AU - Kellum, John A
AU - Peake, Sandra Lois
AU - Pike, Francis
AU - Reade, Michael C
AU - Rowan, Kathy
AU - Singer, Mervyn
AU - Webb, Steven A R
AU - Weissfeld, Lisa A
AU - Yealy, Donald M
AU - Young, John Duncan
PY - 2015
Y1 - 2015
N2 - 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 - 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.
UR - http://goo.gl/7MqEDu
U2 - 10.1007/s00134-015-3822-1
DO - 10.1007/s00134-015-3822-1
M3 - Article
VL - 41
SP - 1549
EP - 1560
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 9
ER -