Protocol-Based Resuscitation for Septic Shock: A Meta-Analysis of Randomized Trials and Observational Studies.
10.3349/ymj.2016.57.5.1260
- Author:
Woo Kyung LEE
1
;
Ha Yeon KIM
;
Jinae LEE
;
Shin Ok KOH
;
Jeong Min KIM
;
Sungwon NA
Author Information
1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. nswksj@yuhs.ac
- Publication Type:Meta-Analysis ; Original Article
- Keywords:
Sepsis;
septic shock;
shock;
meta-analysis
- MeSH:
Humans;
*Observational Studies as Topic;
*Randomized Controlled Trials as Topic;
Resuscitation/*methods;
Shock, Septic/mortality/*therapy
- From:Yonsei Medical Journal
2016;57(5):1260-1270
- CountryRepublic of Korea
- Language:English
-
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 AND METHODS: 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.
