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

 Woo Kyung Lee  ;  Ha Yeon Kim  ;  Jinae Lee  ;  Shin Ok Koh  ;  Jeong Min Kim  ;  Sungwon Na 
 YONSEI MEDICAL JOURNAL, Vol.57(5) : 1-270, 2016 
Journal Title
Issue Date
Humans ; Observational Studies as Topic* ; Randomized Controlled Trials as Topic* ; Resuscitation/methods* ; Shock, Septic/mortality ; Shock, Septic/therapy*
Sepsis ; meta-analysis ; septic shock ; shock
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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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Jeongmin(김정민) ORCID logo https://orcid.org/0000-0002-0468-8012
Kim, Ha Yan(김하연)
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
Lee, Woo Kyung(이우경)
Lee, Jinae(이진애)
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