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The effect of an optimized resuscitation strategy on prognosis of patients with septic shock: a systematic review

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Author:
No author available
Journal Title:
Chinese Critical Care Medicine
Issue:
1
DOI:
10.3760/cma.j.issn.1003-0603.2012.01.004
Key Word:
脓毒症;感染性休克;液体复苏;目标性治疗;随机对照临床试验;系统评价;Sepsis;Septic shock;Fluid resuscitation;Goal-directed therapy;Randomized controlled trial;Systematic review

Abstract: Objective To determine the treatment effect of an optimized resuscitation strategy on prognosis of patients with septic shock.Methods A systematic review of MEDLINE,the Cochrane Library,Embase,CBM,CNKI and other sources using a comprehensive strategy was conducted.All randomized controlled trials (RCTs) of treatment of severe sepsis and septic shock were included.The patients were randomized into treatment group and control group.Preplanned subgroup analysis required studies to be categorized based on early (goal-directed therapy accomplished within 6-24 hours ) vs.late (initiated after 24 hours or unknown time of resuscitation implementation).Two authors independently extracted data and assessed study quality using standardized methods.Consensus was reached by conference.The Cochrance Collaboration's software RevMan 5.0 was used for data analysis.Results Eleven studies were included in the final analysis,providing a sample of 2066 patients.The combined results demonstrated a decrease in mortality [ odds ratio (OR) =0.63,95% confidence interval (95% CI) 0.48-0.84,P=0.002 ] ; however,there was statistically significant heterogeneity (P=0.01,I2=55% ).Among the early optimal resuscitation studies (n=8) there was minimal heterogeneity (P=0.44,I2=0%) and a significant decrease in mortality (OR=0.53,95%CI0.42-0.66,P<0.000 01 ) and incidence of multiple organ dysfunction syndrome (MODS,OR =0.61,95% CI0.43-0.85,P=0.004).For the late resuscitation studies (n=3),there was statistically significant difference (P=0.05,I2=66% ),and there was no significant effect on mortality (OR=0.89,95%CI 0.52-1.54,P=0.68 ) and incidence of MODS (OR=0.43,95%CI 0.17-1.08,P=0.07).Conclusion This meta-analysis found that the application of an early optimal resuscitation strategy to patients with septic shock imparts a significant reduction in mortality and incidence of MODS.

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