Protocol-Based Resuscitation for Septic Shock: A Meta-Analysis of Randomized Trials and Observational Studies
- Authors
- Lee, Woo Kyung; Kim, Ha Yeon; Lee, Jinae; Koh, Shin Ok; Kim, Jeong Min; Na, Sungwon
- Issue Date
- Sep-2016
- Publisher
- YONSEI UNIV COLL MEDICINE
- Keywords
- Sepsis; septic shock; shock; meta-analysis
- Citation
- YONSEI MEDICAL JOURNAL, v.57, no.5, pp 1260 - 1270
- Pages
- 11
- Journal Title
- YONSEI MEDICAL JOURNAL
- Volume
- 57
- Number
- 5
- Start Page
- 1260
- End Page
- 1270
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/64168
- DOI
- 10.3349/ymj.2016.57.5.1260
- ISSN
- 0513-5796
1976-2437
- 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.
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