Journal ArticleDOI
A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators
Derek C. Angus,Amber E. Barnato,Derek Bell,Derek Bell,Rinaldo Bellomo,Rinaldo Bellomo,Cher-Rin Chong,Timothy J Coats,Andrew Ross Davies,Andrew Ross Davies,Anthony Delaney,Anthony Delaney,Anthony Delaney,David A Harrison,Anna Holdgate,Belinda Howe,David T. Huang,Theodore J. Iwashyna,Theodore J. Iwashyna,John A. Kellum,Sandra L. Peake,Sandra L. Peake,Francis Pike,Michael C. Reade,Kathy Rowan,Mervyn Singer,Steven A R Webb,Steven A R Webb,Lisa A. Weissfeld,Donald M. Yealy,J D Young +30 more
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TLDR
EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.Abstract:
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. 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. 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]. EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.read more
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Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Andrew Rhodes,Laura Evans,Waleed Alhazzani,Mitchell M. Levy,Massimo Antonelli,Ricard Ferrer,Anand Kumar,Jonathan E. Sevransky,Charles L. Sprung,Mark E. Nunnally,Bram Rochwerg,Gordon D. Rubenfeld,Derek C. Angus,Djillali Annane,Richard Beale,Geoffrey J. Bellinghan,Gordon R. Bernard,Jean Daniel Chiche,Craig M. Coopersmith,Daniel De Backer,Craig French,Seitaro Fujishima,Herwig Gerlach,Jorge Hidalgo,Steven M. Hollenberg,Alan E. Jones,Dilip R. Karnad,Ruth M. Kleinpell,Younsuck Koh,Thiago Lisboa,Flávia Ribeiro Machado,John J. Marini,John C. Marshall,John E. Mazuski,Lauralyn McIntyre,Anthony S. McLean,Sangeeta Mehta,Rui Moreno,John Myburgh,Paolo Navalesi,Osamu Nishida,Tiffany M. Osborn,Anders Perner,Colleen M. Plunkett,Marco Ranieri,Christa A. Schorr,Maureen A. Seckel,Christopher W. Seymour,Lisa Shieh,Khalid A. Shukri,Steven Q. Simpson,Mervyn Singer,B. Taylor Thompson,Sean R. Townsend,Thomas Van der Poll,Jean Louis Vincent,W. Joost Wiersinga,Janice L. Zimmerman,R. Phillip Dellinger +58 more
TL;DR: Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
Journal ArticleDOI
Early goal-directed therapy in the treatment of severe sepsis and septic shock
Journal ArticleDOI
The Timing of Early Antibiotics and Hospital Mortality in Sepsis
Vincent X. Liu,Vikram Fielding-Singh,John D. Greene,Jennifer M. Baker,Theodore J. Iwashyna,Jay Bhattacharya,Gabriel J. Escobar +6 more
TL;DR: In a large, contemporary, and multicenter sample of patients with sepsis in the emergency department, hourly delays in antibiotic administration were associated with increased odds of hospital mortality even among patients who received antibiotics within 6 hours.
Journal ArticleDOI
Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis.
Prism Investigators,Kathryn M Rowan,Derek C. Angus,Michael Bailey,Amber E. Barnato,Rinaldo Bellomo,Ruth R Canter,Timothy J Coats,Anthony Delaney,Elizabeth Gimbel,Richard Grieve,David A Harrison,Alisa Higgins,Belinda Howe,David T. Huang,John A. Kellum,Paul R Mouncey,Edvin Music,Sandra L. Peake,Sandra L. Peake,Francis Pike,Michael C. Reade,M Zia Sadique,Mervyn Singer,Donald M. Yealy +24 more
TL;DR: In this meta‐analysis of individual patient data, EGDT did not result in better outcomes than usual care and was associated with higher hospitalization costs across a broad range of patient and hospital characteristics.
Journal ArticleDOI
Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial
Peter Buhl Hjortrup,Nicolai Haase,Helle Bundgaard,Simon Thomsen,Robert Winding,Ville Pettilä,Anne Aaen,David Lodahl,Rasmus Ehrenfried Berthelsen,Henrik I. Christensen,Martin Bruun Madsen,Per Winkel,Jørn Wetterslev,Anders Perner +13 more
TL;DR: A protocol restricting resuscitations fluid successfully reduced volumes of resuscitation fluid compared with a standard care protocol in adult ICU patients with septic shock, pointing towards benefit with fluid restriction.
References
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Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
TL;DR: Moher et al. as mentioned in this paper introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses, which is used in this paper.
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Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
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