Protocol-Based Resuscitation for Septic Shock: A Meta-Analysis of Randomized Trials and Observational Studies
Yonsei Medical Journal
; : 1260-1270, 2016.
Article
en En
| WPRIM
| ID: wpr-79765
Biblioteca responsable:
WPRO
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.
Palabras clave
Texto completo:
1
Base de datos:
WPRIM
Asunto principal:
Resucitación
/
Choque Séptico
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Ensayos Clínicos Controlados Aleatorios como Asunto
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Estudios Observacionales como Asunto
Tipo de estudio:
Clinical_trials
/
Guideline
/
Observational_studies
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Yonsei Medical Journal
Año:
2016
Tipo del documento:
Article