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Cited by 55Sepsis Diagnosis and TreatmentHemodynamic Monitoring and TherapyAbdominal Surgery and Complications

Early goal-directed therapy for severe sepsis and septic shock: A living systematic review

Simpson, Steven Q., Gaines, Melissa, Hussein, Youness, Badgett, Robert G.·2016·Journal of Critical Care
DOI 10.1016/j.jcrc.2016.06.017
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Abstract

Studies and meta-analyses conflict regarding the use of early goal-directed therapy (EGDT) for septic shock. We sought to clarify the conflict by performing a living systematic review and meta-regression.Methods We performed a meta-analysis and explored heterogeneity with meta-regression. We conformed with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and qualified strength of evidence with a Grading of Recommendations Assessment, Development and Evaluation profile.Results Overall, EGDT did not significantly reduce mortality compared with usual care (relative risk, 0.85; 95% confidence interval, 0.67-1.08); however, heterogeneity was substantial (I 2=64%; 95% confidence interval, 12%-85%). Illness severity did not correlate with mortality reduction; however, there were significant correlations with control rate mortality and the strategy employed by the control group. Benefit was confined to trials with a control mortality greater than 35%. Compared with monitoring of lactate clearance and central venous pressure, EGDT mortality was higher.Conclusion The benefit of EGDT is evident in populations with high mortality, in line with reported global mortality rates. In settings with low mortality the recent trials challenge the need for 6-hour goals; however, most patients in these trials met 3-hour resuscitation goals as defined by the Surviving Sepsis Campaign. In settings with higher mortality, EGDT or normalization of lactate/central venous pressure may be viable therapeutic options.

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Crossref · 10.1016/j.jcrc.2016.06.017

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  • Normal serum lactate levels are not achievable in all patients with septic shock, but studies support resuscitative strategies that decrease lactate toward normal.

    “The panel recognises that normal serum lactate levels are not achievable in all patients with septic shock, but these studies support resuscitative strategies that decrease lactate toward normal.”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [75]

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Authors
Simpson, S. Q., Gaines, M., Hussein, Y., & Badgett, R. G.
Affiliations
University of Kansas Medical Center (US)
Corresponding author
Simpson, Steven Q.
ORCID
Venue
Journal of Critical Care
Publisher
Elsevier BV
Published
2016-12
Volume
36
Pages
43-48
ISSN
0883-9441 (ISSN-L)
DOI
10.1016/j.jcrc.2016.06.017
OpenAlex
W2460179184
Cited by
55
References
35
Citations by year
2026: 5 · 2025: 5 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 9 · 2019: 2 · 2018: 10 · 2017: 9 · 2016: 1
FWCI
0.99
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Critical Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
Keywords
early goal-directed therapy, septic shock, severe sepsis, mortality, lactate clearance, central venous pressure, fluid resuscitation, Surviving Sepsis Campaign
MeSH terms
Critical Care, Humans, Resuscitation, Shock, Septic, Sepsis, Critical Pathways

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