Protocol-Based Resuscitation for Septic Shock: A Meta-Analysis of Randomized Trials and Observational Studies

• Published in: Yonsei medical journal Vol. 57; no. 5; pp. 1260 - 1270
• Main Authors: Lee, Woo Kyung, Kim, Ha Yeon, Lee, Jinae, Koh, Shin Ok, Kim, Jeong Min, Na, Sungwon
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01-09-2016; 연세대학교의과대학
• Subjects: Humans; Observational Studies as Topic; Original; Randomized Controlled Trials as Topic; Resuscitation - methods; Shock, Septic - mortality; Shock, Septic - therapy; 의학일반; meta-analysis; Sepsis; septic shock; shock
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2016.57.5.1260

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.
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.
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.
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.