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(title:EARLY GOAL-DIRECTED THERAPY AND SEVERE SEPSIS AND SEPTIC SHOCK)

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1. Comparison of Early Goal-Directed Therapy With Usual Care for Severe Sepsis and Septic Shock

Comparison of Early Goal-Directed Therapy With Usual Care for Severe Sepsis and Septic Shock Systematic Review Snapshot TAKE-HOME MESSAGE Compared with unstructured usual care, early goal-directed therapy does not decrease mortality in patients with severe sepsis or septic shock. Comparison of Early Goal-Directed Therapy WithUsualCareforSevereSepsisandSeptic Shock EBEM Commentators Michael Gottlieb, MD John Bailitz, MD Department of Emergency Medicine Cook County Hospital Chicago, IL Results (...) , with differences settled by consensus with a third ANNALS OF EMERGENCY MEDICINE DECEMBER 2015 632 Annals of Emergency Medicine Volume 66, no. 6 : December 2015transfusions, as expected in the control groups in which these interventions were not mandated. Commentary Severe sepsis and septic shock occur frequently and are a leading cause of death in the United States. 1 In 2001, Rivers et al 2 described a speci?c early goal- directed therapy protocol to reduce mortality in patients with severe sepsis or septic

2015 Annals of Emergency Medicine Systematic Review Snapshots

2. The Role of Early Goal-Directed Therapy in Severe Sepsis and Septic Shock

The Role of Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Emergency Medicine > Journal Club > Archive > July 2015 Toggle navigation July 2015 The Role of Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Vignette You are working a shift in TCC one busy afternoon when a patient is brought in by EMS for flank pain and a fever. You enter the room the find a 60­‐year female with a history of hypertension who is in no distress. She complains of dysuria, right flank pain (...) of fluid, and you don’t plan to place a central line for pressors, so wonder if it’s really necessary. After discussion with the attending you decide to hold off on the central line and admit the patient to the ICU, but after your shift you consider your question again and begin searching the literature for answers. PICO Question #1 Population: Adult patients with severe sepsis or septic shock Intervention: Early goal-directed therapy Comparison: Usual care or other standardized protocols Outcome

2015 Washington University Emergency Medicine Journal Club

3. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department

Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?

2011 PedsCCM Evidence-Based Journal Club

4. Prognostic utility of plasma lactate measured between 24 and 48 h after initiation of early goal-directed therapy in the management of sepsis, severe sepsis, and septic shock (PubMed)

Prognostic utility of plasma lactate measured between 24 and 48 h after initiation of early goal-directed therapy in the management of sepsis, severe sepsis, and septic shock Based on the proven efficacy of lactate in predicting mortality and morbidity in sepsis when measured early in the resuscitative protocol, our group hypothesized that this utility extends later in the course of care. This study sought to investigate the prognostic potential of plasma lactate clearance measured 24-48 h (...) after the initiation of treatment for nonsurgical patients with sepsis, severe sepsis, and septic shock.Plasma lactate values, measured 24-48 h after the initiation of treatment, were collected in nonsurgical septic, severe septic, and septic shock patients. The primary outcome was 30-day mortality, while secondary outcomes included requirements for vasopressors and boluses of intravenous fluids. Analysis of these three outcomes was performed while controlling for clinical severity as measured

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2016 Journal of intensive care

5. Samu Save Sepsis: Early Goal Directed Therapy in Pre Hospital Care of Patients With Severe Sepsis and/or Septic Shock

Samu Save Sepsis: Early Goal Directed Therapy in Pre Hospital Care of Patients With Severe Sepsis and/or Septic Shock Samu Save Sepsis: Early Goal Directed Therapy in Pre Hospital Care of Patients With Severe Sepsis and/or Septic Shock - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number (...) of saved studies (100). Please remove one or more studies before adding more. Samu Save Sepsis: Early Goal Directed Therapy in Pre Hospital Care of Patients With Severe Sepsis and/or Septic Shock (SSS) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02473263 Recruitment Status : Active, not recruiting

2015 Clinical Trials

6. Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE (PubMed)

Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care (...) a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate

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2016 Critical Care

7. The effect of early goal-directed therapy for treatment of severe sepsis or septic shock: A systemic review and meta-analysis. (PubMed)

The effect of early goal-directed therapy for treatment of severe sepsis or septic shock: A systemic review and meta-analysis. To assess the effects of early goal-directed therapy (EGDT) on reducing mortality compared with conventional management of severe sepsis or septic shock.We included a systemic review, using the Medline and EMBASE. Seventeen randomized trials with 5765 patients comparing EGDT with usual care were included.There were no significant differences in mortality between EGDT (...) and 2012 Surviving Sepsis Campaign guidelines, but not before and after these publications.This meta-analysis was heavily influenced by the recent addition of the trio of trials published after 2014. The results of the recent trio of trials may be biased due to methodological issues. This includes lack of blinding by incorporating similar diagnostic and therapeutic interventions as the original EGDT trial.Copyright © 2016 Elsevier Inc. All rights reserved.

2016 Journal of critical care

8. Early goal-directed therapy for severe sepsis and septic shock: A living systematic review. (PubMed)

Early goal-directed therapy for severe sepsis and septic shock: A living systematic review. Studies and meta-analyses conflict regarding the use of early goal-directed therapy (EGDT) for septic shock. We sought to clarify the conflict by performing a living systematic review and meta-regression.We performed a meta-analysis and explored heterogeneity with meta-regression. We conformed with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and qualified strength (...) was confined to trials with a control mortality greater than 35%. Compared with monitoring of lactate clearance and central venous pressure, EGDT mortality was higher.The benefit of EGDT is evident in populations with high mortality, in line with reported global mortality rates. In settings with low mortality the recent trials challenge the need for 6-hour goals; however, most patients in these trials met 3-hour resuscitation goals as defined by the Surviving Sepsis Campaign. In settings with higher

2016 Journal of critical care

9. The Effect of Early Goal-Directed Therapy on Outcome in Adult Severe Sepsis and Septic Shock Patients: A Meta-Analysis of Randomized Clinical Trials. (PubMed)

The Effect of Early Goal-Directed Therapy on Outcome in Adult Severe Sepsis and Septic Shock Patients: A Meta-Analysis of Randomized Clinical Trials. Whether early goal-directed therapy (EGDT) improves outcome in severe sepsis and septic shock remains unclear. We performed a meta-analysis of existing clinical trials to examine whether EGDT improved outcome in the resuscitation of adult sepsis patients compared with control care.We searched for eligible studies using MEDLINE, Elsevier, Cochrane (...) Central Register of Controlled Trials, and Web of Science databases. Studies were eligible if they compared the effects of EGDT versus control care on mortality in adult patients with severe sepsis and septic shock. Two reviewers extracted data independently. Data including mortality, sample size of the patients with severe sepsis and septic shock, and resuscitation end points were extracted. Data were analyzed using methods recommended by the Cochrane Collaboration Review Manager 4.2 software. Random

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2016 Anesthesia and Analgesia

10. Effect of early goal directed therapy in the treatment of severe sepsis and/or septic shock: A meta-Analysis. (PubMed)

Effect of early goal directed therapy in the treatment of severe sepsis and/or septic shock: A meta-Analysis. Many investigators have reproduced the mortality reduction shown in the original trial of early goal directed therapy (EGDT) in patients with severe sepsis and/or septic shock. Three large randomized controlled trials (RCTs) found neutral results when compared to usual care and a modified form of EGDT. Some have interpreted these studies as a reason to question the efficacy of EGDT.The (...) purpose of this study was to comprehensively examine the effect of EGDT in the treatment of severe sepsis and/or septic shock in the literature.A systematic review and meta-analysis of RCTs and prospective studies were performed, which extracted studies from PubMed, Elsevier ScienceDirect, Cochrane, Clinicaltrials.gov, Google Scholar, China Knowledge Resource Integrated Database, and Wanfang Database. The mortality trend in the control group from included studies was analyzed.Seven RCTs and twelve

2016 Current medical research and opinion

11. The effect of early goal-directed therapy on mortality in patients with severe sepsis and septic shock: a meta-analysis. (PubMed)

The effect of early goal-directed therapy on mortality in patients with severe sepsis and septic shock: a meta-analysis. The Surviving Sepsis Campaign has recommended early goal-directed therapy (EGDT) as an essential strategy to decrease mortality among patients with severe sepsis and septic shock. However, three latest multicenter trials failed to show its benefit in the patients with severe sepsis and septic shock. This article was to evaluate the effect of EGDT on the mortality of patients (...) with severe sepsis and septic shock.Relevant studies from PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were identified from January 1, 2001 to June 13, 2015. With both randomized controlled trials (RCTs) and non-RCTs selected, a meta-analysis on the effects of EGDT on all identified trials was performed. The primary outcome was the inhospital mortality. In subgroup, RCTs and non-RCTs were analyzed, respectively.A total of five RCTs and 10 non-RCTs involving 3285

2016 The Journal of surgical research

12. Early Goal-Directed Therapy in Severe Sepsis and Septic Shock: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. (PubMed)

Early Goal-Directed Therapy in Severe Sepsis and Septic Shock: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. The Surviving Sepsis Campaign guidelines recommend early goal-directed therapy (EGDT) for the resuscitation of patients with sepsis; however, the recent evidences quickly evolve and convey conflicting results. We performed a meta-analysis to evaluate the effect of EGDT on mortality in adults with severe sepsis and septic shock.We searched electronic (...) databases to identify randomized controlled trials that compared EGDT with usual care or lactate-guided therapy in adults with severe sepsis and septic shock. Predefined primary outcome was all-cause mortality at final follow-up.We included 13 trials enrolling 5268 patients. Compared with usual care, EGDT was associated with decreased mortality (risk ratio [RR]: 0.87, 95% CI: 0.77-0.98; 4664 patients, 8 trials; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] quality

2016 Journal of intensive care medicine

14. Effect of early goal-directed therapy on mortality in patients with severe sepsis or septic shock: a meta-analysis of randomised controlled trials. (PubMed)

Effect of early goal-directed therapy on mortality in patients with severe sepsis or septic shock: a meta-analysis of randomised controlled trials. To determine whether patients with severe sepsis or septic shock could benefit from a strict and early goal-directed therapy (EGDT) protocol recommended by Surviving Sepsis Campaign (SSC) Guidelines.MEDLINE/PubMed, EMBASE/OVID and Cochrane Central Register of Controlled Trials (CENTRAL) were searched between March 1983 and March 2015. Eligible (...) studies evaluated the outcomes of EGDT versus usual care or standard therapy in patients with severe sepsis or septic shock. The primary outcomes were mortality within 28 days, 60 days and 90 days. Included studies must report at least one metric of mortality.5 studies that enrolled 4303 patients with 2144 in the EGDT group and 2159 in the control group were included in this meta-analysis. Overall, there were slight decreases of mortality within 28 days, 60 days and 90 days in the random-effect model

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2016 BMJ open

15. [Effect of early goal-directed therapy on mortality in patients with severe sepsis or septic shock: a Meta analysis]. (PubMed)

[Effect of early goal-directed therapy on mortality in patients with severe sepsis or septic shock: a Meta analysis]. To investigate whether early goal-directed therapy (EGDT) could improve the mortality rate in patients with severe sepsis or septic shock.Articles were retrieved from PubMed, Cochrane Library, Embase data, Wanfang data, and CNKI from January 1980 to May 2015. Inclusion criteria included the subjects concerning patients with severe sepsis or septic shock reported as randomized (...) controlled trial (RCT), clinical controlled trial (CCT), case-control studies, cohort studies with complete data, which endpoints were the short-term mortality [in-hospital, intensive care unit (ICU) or 28-day] and long-term mortality (60-day, 90-day or 1 year). RevMan 5.2 software was used for Meta analysis of effect of EGDT on mortality rate in patients with severe sepsis or septic shock, and funnel plot was drawn to evaluate the quality of enrolled literature.There were 12 studies meeting inclusive

2016 Zhonghua wei zhong bing ji jiu yi xue

16. [The effects of early goal-directed therapy on mortality rate in patients with severe sepsis and septic shock: a systematic literature review and Meta-analysis]. (PubMed)

[The effects of early goal-directed therapy on mortality rate in patients with severe sepsis and septic shock: a systematic literature review and Meta-analysis]. To investigate whether early goal-directed therapy (EGDT) could lower the mortality rate in patients with severe sepsis and septic shock.Articles with items sepsis, severe sepsis, septic shock, EGDT were retrieved from MEDLINE, EMBASE, Cochrane, Wanfang Data and CNKI. Inclusion criteria included randomized controlled trial, subjects (...) concerning patients with severe sepsis or septic shock, endpoints with short-term mortality [ in-hospital, intensive care unit (ICU) or 28-day] and long-term mortality (60-day or 90-day). Related risk (RR) and 95% confidence interval (95%CI) were used as indices to judge the difference in mortality rate between EGDT group and standard treatment group. RevMan 5.2 software was used for Meta analysis.There were 8 studies meeting inclusive criteria with a total of 4,853 patients. For patients with severe

2015 Zhonghua wei zhong bing ji jiu yi xue

17. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy (PubMed)

The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy Sepsis, including severe sepsis and septic shock, is a major cause of morbidity and mortality. Albumin and C-reactive protein (CRP) are considered as good diagnostic markers for sepsis. Thus, initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients (...) with severe sepsis and septic shock.We conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and who had received a standardized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock, from November 2007 to February 2013, at a tertiary hospital in Seoul, Korea. The outcome measured was 180-day all-cause mortality. A multivariate Cox proportional hazard model was used to identify the independent risk

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2015 PloS one

18. Early goal-directed therapy reduces mortality in adult patients with severe sepsis and septic shock: Systematic review and meta-analysis. (PubMed)

Early goal-directed therapy reduces mortality in adult patients with severe sepsis and septic shock: Systematic review and meta-analysis. Survival sepsis campaign guidelines have promoted early goal-directed therapy (EGDT) as a means for reduction of mortality. On the other hand, there were conflicting results coming out of recently published meta-analyses on mortality benefits of EGDT in patients with severe sepsis and septic shock. On top of that, the findings of three recently done (...) randomized clinical trials (RCTs) showed no survival benefit by employing EGDT compared to usual care. Therefore, we aimed to do a meta-analysis to evaluate the effect of EGDT on mortality in severe sepsis and septic shock patients.We included RCTs that compared EGDT with usual care in our meta-analysis. We searched in Hinari, PubMed, EMBASE, and Cochrane central register of controlled trials electronic databases and other articles manually from lists of references of extracted articles. Our primary end

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2015 Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

19. Early goal-directed therapy vs usual care in the treatment of severe sepsis and septic shock: a systematic review and meta-analysis. (PubMed)

Early goal-directed therapy vs usual care in the treatment of severe sepsis and septic shock: a systematic review and meta-analysis. Sepsis is a common and high-burden healthcare problem with a mortality exceeding 20 % in severe sepsis and nearly 50 % when septic shock is present. Early goal-directed therapy (EGDT) is recommended by sepsis guidelines as the standard of care following a landmark study by Rivers et al. alongside other observational studies. Three recent randomized controlled (...) trials have questioned the Rivers' results. The objective of our systematic review was to assess the effectiveness of EGDT in reducing the mortality of severe sepsis or septic shock. Relevant primary studies were identified by searching the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Clinical Trials to identify randomized controlled trials assessing the effectiveness of EGDT for sepsis. Data from all trials were combined and analyzed using a random effects model. Five

2015 Internal and emergency medicine

20. Randomized controlled trials testing sepsis bundle use with early goal directed therapy for the treatment of sepsis, severe sepsis, and septic shock: a systematic review and meta-analysis

Randomized controlled trials testing sepsis bundle use with early goal directed therapy for the treatment of sepsis, severe sepsis, and septic shock: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites (...) . No control group 5. Combination therapy or contamination 6. Not about analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data are not reported or unclear, we

2014 PROSPERO

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