Protocol-based resuscitation for septic shock: A meta-analysis of randomized trials and observational studies

Woo Kyung Lee, Ha Yeon Kim, Jinae Lee, Shin Ok Koh, Jeong Min Kim, Sungwon Na

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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.

Original languageEnglish
Pages (from-to)1260-1270
Number of pages11
JournalYonsei Medical Journal
Volume57
Issue number5
DOIs
StatePublished - Sep 2016

Keywords

  • Meta-analysis
  • Sepsis
  • Septic shock
  • Shock

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