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Meta-Analysis
. 2014 Feb;15(1):51-9.
doi: 10.5811/westjem.2013.7.6828.

Meta-analysis of protocolized goal-directed hemodynamic optimization for the management of severe sepsis and septic shock in the Emergency Department

Charles R Wira  1 , Kelly Dodge  1 , John Sather  2 , James Dziura  1
Affiliations
Meta-Analysis

Meta-analysis of protocolized goal-directed hemodynamic optimization for the management of severe sepsis and septic shock in the Emergency Department

Charles R Wira et al. West J Emerg Med. 2014 Feb.

Abstract

Introduction: To perform a meta-analysis identifying studies instituting protocolized hemodynamic optimization in the emergency department (ED) for patients with severe sepsis and septic shock.

Methods: We modeled the structure of this analysis after the QUORUM and MOOSE published recommendations for scientific reviews. A computer search to identify articles was performed from 1980 to present. Studies included for analysis were adult controlled trials implementing protocolized hemodynamic optimization in the ED for patients with severe sepsis and septic shock. Primary outcome data was extracted and analyzed by 2 reviewers with the primary endpoint being short-term mortality reported either as 28-day or in-hospital mortality.

Results: We identified 1,323 articles with 65 retrieved for review. After application of inclusion and exclusion criteria 25 studies (15 manuscripts, 10 abstracts) were included for analysis (n=9597). The mortality rate for patients receiving protocolized hemodynamic optimization (n=6031) was 25.8% contrasted to 41.6% in control groups (n=3566, p<0.0001).

Conclusion: Protocolized hemodynamic optimization in the ED for patients with severe sepsis and septic shock appears to reduce mortality.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Figure 1.
Figure 1.
Flow chart of article extraction. EGDT, early goal-directed therapy.
Figure 2.
Figure 2.
Relative risk of individual trials. Error bars indicate 95% confidence intervals. The pooled risk estimates are shown as diamonds.
Figure 3.
Figure 3.
Number of sepsis abstracts at SAEM and ACEP national conferences since 2001. SAEM, Society for Academic Emergency Medicine Annual Meeting; ACEP, American College of Emergency Physicians Research Forum.
See this image and copyright information in PMC

References

    1. Friedman G, Silva E, Vincent JL. Has the mortality of septic shock changed with time? Crit Care Med. 1998;26:2078–2086. - PubMed
    1. Martin GS, Mannino DM, Eaton S et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–1554. - PubMed
    1. Fromm R, Gibbs L, McCallum W et al. Critical care in the emergency department: a time based study. Crit Care Med. 1993;21:970–976. - PubMed
    1. Wang HE, Shapiro NI, Angus DC et al. National Estimates of Severe Sepsis in United States Emergency Departments. Crit Care Med. 2007;35:1928–1936. - PubMed
    1. Angus DC, Linde-Zwirble WT, Lidicker J et al. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–1310. - PubMed

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