Early goal-directed therapy vs usual care in the treatment of severe sepsis and septic shock: a systematic review and meta-analysis

@article{Rusconi2015EarlyGT,
  title={Early goal-directed therapy vs usual care in the treatment of severe sepsis and septic shock: a systematic review and meta-analysis},
  author={Anna Maria Rusconi and Ilaria Bossi and J Geoffrey Lampard and Michael Szava-Kovats and Andrea Bellone and Eddy S. Lang},
  journal={Internal and Emergency Medicine},
  year={2015},
  volume={10},
  pages={731-743}
}
Sepsis is a common and high-burden healthcare problem with a mortality exceeding 20 % in severe sepsis and nearly 50 % when septic shock is present. Early goal-directed therapy (EGDT) is recommended by sepsis guidelines as the standard of care following a landmark study by Rivers et al. alongside other observational studies. Three recent randomized controlled trials have questioned the Rivers’ results. The objective of our systematic review was to assess the effectiveness of EGDT in reducing… 
The Effect of Early Goal-Directed Therapy on Outcome in Adult Severe Sepsis and Septic Shock Patients: A Meta-Analysis of Randomized Clinical Trials
TLDR
A meta-analysis of existing clinical trials to examine whether EGDT improved outcome in the resuscitation of adult sepsis patients compared with control care found a nonsignificant trend toward reduction in the longest all-cause mortality in patients resuscitated with EGDT was noted.
Early Goal-Directed Therapy in Severe Sepsis and Septic Shock: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials
TLDR
Adults with severe sepsis and septic shock who received EGDT had a lower mortality than those given usual care, the benefit may mainly be attributed to treatments administered within the first 6 hours.
Effect of early goal directed therapy in the treatment of severe sepsis and/or septic shock
TLDR
EGDT significantly reduced mortality in patients with severe sepsis and/or septic shock over 15 years since its publication, and the benefit of EGDT on overall mortality has become comparable with the usual care for sepsi patients.
Early goal-directed treatment versus standard care in management of early septic shock: Meta-analysis of randomized trials
TLDR
EGDT seems to increase the resource demand in terms of ICU admissions and cardiocirculatory support necessity without reducing mortality, renal and respiratory organ support necessity, respiratory and cardioeconomic support duration, and length of hospital stay.
Early Goal-Directed Therapy for Sepsis: A Novel Solution for Discordant Survival Outcomes in Clinical Trials
TLDR
Survival discordance was not associated with differences in early goal-directed therapy bundle compliance or hemodynamic goal achievement, and the results suggest that it was associated with faster and more appropriate antibiotic co-intervention in the early goalsdirected therapy arm compared with controls in the observational studies but not in the randomized trials.
Quality assessment of meta-analyses evaluating randomized clinical trials to improve the prognosis of septic shock: an overview of systematic reviews
TLDR
The methods used to obtain the results should be taken into account when recommending an intervention to treat septic shock if the evidence comes from a meta-analysis of the analyzed characteristics.
1.5 CE Test Hours: A Review of the Revised Sepsis Care Bundles.
TLDR
Recent revisions to the sepsis care bundles are reviewed and screening and assessment tools nurses can use to identify sepsi in the ICU, in the ED, on the medical– surgical unit, and outside the hospital are discussed.
Septic Shock: Advances in Diagnosis and Treatment.
TLDR
Clinicians should understand the importance of prompt administration of intravenous fluids and vasoactive medications aimed at restoring adequate circulation, and the limitations of protocol-based therapy, as guided by recent evidence.
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TLDR
It is suggested that GDT significantly reduces overall mortality in patients with sepsis, especially when initiated early, however, owing to the variable quality of the studies, strong and definitive recommendations cannot be made.
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TLDR
Study of fluid-based interventions should utilize inclusion criteria to accurately capture patients with hypovolemia and tissue hypoperfusion who are most likely to benefit from fluids, and exclusion of patients with severe respiratory distress should be considered when ventilatory support is not readily available.
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TLDR
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TLDR
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TLDR
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TLDR
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TLDR
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