The effect of a quantitative resuscitation strategy on mortality in patients with sepsis: A meta-analysis

TY - JOUR

T1 - The effect of a quantitative resuscitation strategy on mortality in patients with sepsis

T2 - A meta-analysis

AU - Jones, Alan E.

AU - Brown, Michael D.

AU - Trzeciak, Stephen

AU - Shapiro, Nathan I.

AU - Garrett, John S.

AU - Heffner, Alan C.

AU - Kline, Jeffrey A.

PY - 2008

Y1 - 2008

N2 - OBJECTIVE: Quantitative resuscitation consists of structured cardiovascular intervention targeting predefined hemodynamic end points. We sought to measure the treatment effect of quantitative resuscitation on mortality from sepsis. DATA SOURCES: We conducted a systematic review of the Cochrane Library, MEDLINE, EMBASE, CINAHL, conference proceedings, clinical practice guidelines, and other sources using a comprehensive strategy. STUDY SELECTION: We identified randomized control trials comparing quantitative resuscitation with standard resuscitation in adult patients who were diagnosed with sepsis using standard criteria. The primary outcome variable was mortality. DATA ABSTRACTION: Three authors independently extracted data and assessed study quality using standardized instruments; consensus was reached by conference. Preplanned subgroup analysis required studies to be categorized based on early (at the time of diagnosis) vs. late resuscitation implementation. We used the chi-square test and I to assess for statistical heterogeneity (p < 0.10, I > 25%). The primary analysis was based on the random effects model to produce pooled odds ratios with 95% confidence intervals. RESULTS: The search yielded 29 potential publications; nine studies were included in the final analysis, providing a sample of 1001 patients. The combined results demonstrate a decrease in mortality (odds ratio 0.64, 95% confidence interval 0.43-0.96); however, there was statistically significant heterogeneity (p ≤ 0.07, I ≤ 45%). Among the early quantitative resuscitation studies (n ≤ 6) there was minimal heterogeneity (p ≤ 0.40, I ≤ 2.4%) and a significant decrease in mortality (odds ratio 0.50, 95% confidence interval 0.37-0.69). The late quantitative resuscitation studies (n ≤ 3) demonstrated no significant effect on mortality (odds ratio 1.16, 95% confidence interval 0.60-2.22). CONCLUSION: This meta-analysis found that applying an early quantitative resuscitation strategy to patients with sepsis imparts a significant reduction in mortality.

AB - OBJECTIVE: Quantitative resuscitation consists of structured cardiovascular intervention targeting predefined hemodynamic end points. We sought to measure the treatment effect of quantitative resuscitation on mortality from sepsis. DATA SOURCES: We conducted a systematic review of the Cochrane Library, MEDLINE, EMBASE, CINAHL, conference proceedings, clinical practice guidelines, and other sources using a comprehensive strategy. STUDY SELECTION: We identified randomized control trials comparing quantitative resuscitation with standard resuscitation in adult patients who were diagnosed with sepsis using standard criteria. The primary outcome variable was mortality. DATA ABSTRACTION: Three authors independently extracted data and assessed study quality using standardized instruments; consensus was reached by conference. Preplanned subgroup analysis required studies to be categorized based on early (at the time of diagnosis) vs. late resuscitation implementation. We used the chi-square test and I to assess for statistical heterogeneity (p < 0.10, I > 25%). The primary analysis was based on the random effects model to produce pooled odds ratios with 95% confidence intervals. RESULTS: The search yielded 29 potential publications; nine studies were included in the final analysis, providing a sample of 1001 patients. The combined results demonstrate a decrease in mortality (odds ratio 0.64, 95% confidence interval 0.43-0.96); however, there was statistically significant heterogeneity (p ≤ 0.07, I ≤ 45%). Among the early quantitative resuscitation studies (n ≤ 6) there was minimal heterogeneity (p ≤ 0.40, I ≤ 2.4%) and a significant decrease in mortality (odds ratio 0.50, 95% confidence interval 0.37-0.69). The late quantitative resuscitation studies (n ≤ 3) demonstrated no significant effect on mortality (odds ratio 1.16, 95% confidence interval 0.60-2.22). CONCLUSION: This meta-analysis found that applying an early quantitative resuscitation strategy to patients with sepsis imparts a significant reduction in mortality.

UR - https://www.scopus.com/pages/publications/54549122745

UR - https://www.scopus.com/pages/publications/54549122745#tab=citedBy

U2 - 10.1097/CCM.0b013e318186f839

DO - 10.1097/CCM.0b013e318186f839

M3 - Article

C2 - 18766093

SN - 0090-3493

VL - 36

SP - 2734

EP - 2739

JO - Critical care medicine

JF - Critical care medicine

IS - 10

ER -