Imperial College London
Alternate

Emeritus ProfessorDerekBell

Faculty of Medicine, School of Public Health

Emeritus Professor in Acute Medicine
 
 
 
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Contact

 

+44 (0)7886 725 212d.bell

 
 
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Assistant

 

Miss Heather Barnes +44 (0)20 3315 8144

 
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Location

 

Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Citation

BibTex format

@article{Angus:2015:10.1007/s00134-015-3822-1,
author = {Angus, DC and Barnato, AE and Bell, D and Bellomo, R and Chong, C-R and Coats, TJ and Davies, A and Delaney, A and Harrison, DA and Holdgate, A and Howe, B and Huang, DT and Iwashyna, T and Kellum, JA and Peake, SL and Pike, F and Reade, MC and Rowan, KM and Singer, M and Webb, SAR and Weissfeld, LA and Yealy, DM and Young, JD},
doi = {10.1007/s00134-015-3822-1},
journal = {Intensive Care Medicine},
pages = {1549--1560},
title = {A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators},
url = {http://dx.doi.org/10.1007/s00134-015-3822-1},
volume = {41},
year = {2015}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - PurposeTo determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock.MethodsUsing a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay.ResultsFrom 2395 initially eligible abstracts, five randomised clinical trials (n = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2 % [495/2134] versus control: 22.4 % [582/2601]; pooled OR 1.01 [95 % CI 0.88–1.16], P = 0.9, with heterogeneity [I 2 = 57 %; P = 0.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n = 4063) also showed no difference [pooled OR 0.99 (95 % CI 0.86–1.15), P = 0.93] with no heterogeneity (I 2 = 0.0 %; P = 0.97). EGDT increased vasopressor use (OR 1.25 [95 % CI 1.10–1.41]; P < 0.001) and ICU admission [OR 2.19 (95 % CI 1.82–2.65); P < 0.001]. Including six non-ED randomised trials increased heterogeneity (I 2 = 71 %; P < 0.001) but did not change overall results [pooled OR 0.94 (95 % CI 0.82 to 1.07); P = 0.33].ConclusionEGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.
AU  - Angus,DC
AU  - Barnato,AE
AU  - Bell,D
AU  - Bellomo,R
AU  - Chong,C-R
AU  - Coats,TJ
AU  - Davies,A
AU  - Delaney,A
AU  - Harrison,DA
AU  - Holdgate,A
AU  - Howe,B
AU  - Huang,DT
AU  - Iwashyna,T
AU  - Kellum,JA
AU  - Peake,SL
AU  - Pike,F
AU  - Reade,MC
AU  - Rowan,KM
AU  - Singer,M
AU  - Webb,SAR
AU  - Weissfeld,LA
AU  - Yealy,DM
AU  - Young,JD
DO  - 10.1007/s00134-015-3822-1
EP  - 1560
PY  - 2015///
SN  - 0342-4642
SP  - 1549
TI  - A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators
T2  - Intensive Care Medicine
UR  - http://dx.doi.org/10.1007/s00134-015-3822-1
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000360314900004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://link.springer.com/article/10.1007%2Fs00134-015-3822-1
VL  - 41
ER  -
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