The effect of early goal-directed therapy for treatment of severe sepsis or septic shock: a systemic review and meta-analysis

• Published in: Journal of critical care Vol. 38; pp. 115 - 122
• Main Authors: Park, Sun-Kyung, MD, Shin, Su Rin, MD, Hur, Min, MD, Kim, Won Ho, MD,PhD, Oh, Eun-Ah, MD, Soo, Hee Lee, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017; Elsevier Limited
• Subjects: Antibiotics; Bias; Critical Care; Critical Pathways; Goal-directed therapy; Handbooks; Humans; Meta-analysis; Mortality; Resuscitation - methods; Sepsis; Sepsis - mortality; Sepsis - therapy; Shock, Septic - mortality; Shock, Septic - therapy; Short term; Studies; United Kingdom > UK; Australia; United States > US; meta-analysis; mortality; goal-directed therapy; sepsis; Goal-directed therapy; Sepsis; Mortality; Meta-analysis
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2016.10.019

Abstract Purpose To assess the effects of early goal directed therapy (EGDT) on reducing mortality compared to conventional management of severe sepsis or septic shock. Materials and Methods We included a systemic review, using the Medline and EMBASE. Seventeen randomized trials with 5765 patients comparing EGDT with usual care were included. Results There were no significant differences in mortality between EGDT and control groups (relative risk [RR] 0.89, 95% confidence interval [CI], 0.79 to 1.00), with moderate heterogeneity (I2 = 56%). EGDT was associated with lower mortality rates when the mortality rate of the usual care group was greater than 30% (12 trials; RR 0.83; 95% CI, 0.72 to 0.96), but not when the mortality rate in the usual care group was less than 30% (5 trials; RR 1.03; 95% CI, 0.92 to 1.16). The mortality benefit was seen only in subgroup of population analyzed between publication of the 2004 and 2012 Surviving Sepsis Campaign (SSC) guidelines, but not before and after these publications. Conclusion This meta-analysis was heavily influenced by the recent addition of the trio of trials published after 2014. The results of the recent trio of trials may be biased due methodological issues. This includes lack of blinding by incorporating similar diagnostic and therapeutic interventions as the original EGDT trial.