A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators

Angus, D.C, Barnato, A.E, Bell, D, Bellomo, R, Chong, C.-R, Coats, T.J, Davies, A, Delaney, A, Harrison, D.A, Holdgate, A, Howe, B, Huang, D.T, Iwashyna, T, Kellum, J.A, Peake, S.L, Pike, F, Reade, M.C, Rowan, K.M, Singer, M, Webb, S.A.R, Weissfeld, L.A, Yealy, D.M and Young, J.D (2015) A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. Intensive Care Medicine, 41 9: 1549-1560. doi:10.1007/s00134-015-3822-1


Author Angus, D.C
Barnato, A.E
Bell, D
Bellomo, R
Chong, C.-R
Coats, T.J
Davies, A
Delaney, A
Harrison, D.A
Holdgate, A
Howe, B
Huang, D.T
Iwashyna, T
Kellum, J.A
Peake, S.L
Pike, F
Reade, M.C
Rowan, K.M
Singer, M
Webb, S.A.R
Weissfeld, L.A
Yealy, D.M
Young, J.D
Title A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 1432-1238
0342-4642
Publication date 2015-05-08
Year available 2015
Sub-type Article (original research)
DOI 10.1007/s00134-015-3822-1
Open Access Status Not yet assessed
Volume 41
Issue 9
Start page 1549
End page 1560
Total pages 12
Place of publication Heidelberg, Germany
Publisher Springer Verlag
Collection year 2016
Language eng
Formatted abstract
Purpose
To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock.

Methods
Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay.

Results
From 2395 initially eligible abstracts, five randomised clinical trials (n = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2 % [495/2134] versus control: 22.4 % [582/2601]; pooled OR 1.01 [95 % CI 0.88–1.16], P = 0.9, with heterogeneity [I 2 = 57 %; P = 0.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n = 4063) also showed no difference [pooled OR 0.99 (95 % CI 0.86–1.15), P = 0.93] with no heterogeneity (I 2 = 0.0 %; P = 0.97). EGDT increased vasopressor use (OR 1.25 [95 % CI 1.10–1.41]; P < 0.001) and ICU admission [OR 2.19 (95 % CI 1.82–2.65); P < 0.001]. Including six non-ED randomised trials increased heterogeneity (I 2 = 71 %; P < 0.001) but did not change overall results [pooled OR 0.94 (95 % CI 0.82 to 1.07); P = 0.33].

Conclusion
EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.
Keyword Early goal-directed therapy or EGDT
Resuscitation
Septic shock
Central venous oxygen saturation
Meta-analysis
Systematic review
Randomised clinical trials
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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