Protocol-Based Resuscitation for Septic Shock: A Meta-Analysis of Randomized Trials and Observational Studies
Yonsei Medical Journal
;
: 1260-1270, 2016.
Article
in English
| WPRIM
| ID: wpr-79765
ABSTRACT
PURPOSE:
Owing to the recommendations of the Surviving Sepsis Campaign guidelines, protocol-based resuscitation or goal-directed therapy (GDT) is broadly advocated for the treatment of septic shock. However, the most recently published trials showed no survival benefit from protocol-based resuscitation in septic shock patients. Hence, we aimed to assess the effect of GDT on clinical outcomes in such patients. MATERIALS ANDMETHODS:
We performed a systematic review that included a meta-analysis. We used electronic search engines including PubMed, Embase, and the Cochrane database to find studies comparing protocol-based GDT to common or standard care in patients with septic shock and severe sepsis.RESULTS:
A total of 13269 septic shock patients in 24 studies were included [12 randomized controlled trials (RCTs) and 12 observational studies]. The overall mortality odds ratio (OR) [95% confidence interval (CI)] for GDT versus conventional care was 0.746 (0.631-0.883). In RCTs only, the mortality OR (95% CI) for GDT versus conventional care in the meta-analysis was 0.93 (0.75-1.16). The beneficial effect of GDT decreased as more recent studies were added in an alternative, cumulative meta-analysis. No significant publication bias was found.CONCLUSION:
The result of this meta-analysis suggests that GDT reduces mortality in patients with severe sepsis or septic shock. However, our cumulative meta-analysis revealed that the reduction of mortality risk was diminished as more recent studies were added.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Resuscitation
/
Shock, Septic
/
Randomized Controlled Trials as Topic
/
Observational Studies as Topic
Type of study:
Controlled clinical trial
/
Practice guideline
/
Observational study
/
Systematic reviews
Limits:
Humans
Language:
English
Journal:
Yonsei Medical Journal
Year:
2016
Type:
Article
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