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

Abstract

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.

• Authors: Alan E Jones, Michael D Brown, Stephen Trzeciak, Nathan I Shapiro, John S Garrett, Alan C Heffner, Jeffrey A Kline, Emergency Medicine Shock Research Network investigators
• Journal: Critical care medicine (Crit Care Med) Vol. 36 Issue 10 Pg. 2734-9 (Oct 2008) ISSN: 1530-0293 [Electronic] United States
• PMID: 18766093 (Publication Type: Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Review, Systematic Review)

Topics

• Cause of Death
• Critical Care (methods)
• Female
• Hospital Mortality
• Humans
• Male
• Observer Variation
• Randomized Controlled Trials as Topic
• Resuscitation (mortality, standards)
• Risk Assessment
• Sensitivity and Specificity
• Sepsis (diagnosis, mortality, therapy)
• Shock, Septic (diagnosis, mortality, therapy)
• Survival Analysis