SynthesisCritical care (London, England)2014
The effect of goal-directed therapy on mortality in patients with sepsis - earlier is better: a meta-analysis of randomized controlled trials.
Synthesis in Critical care (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 9 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 9 syntheses or guidelines pooled it, 92 citations in OpenAlex.
- Early goal-directed and lactate-guided therapy in adult patients with severe sepsis and septic shock: a meta-analysis of randomized controlled trials.Journal of translational medicine · 2018Pooled it
- Impact of hemodynamic goal-directed resuscitation on mortality in adult critically ill patients: a systematic review and meta-analysis.Journal of clinical monitoring and computing · 2018Pooled it
- Protocol-Based Resuscitation for Septic Shock: A Meta-Analysis of Randomized Trials and Observational Studies.Yonsei medical journal · 2016Pooled it
- Identification of adults with sepsis in the prehospital environment: a systematic review.BMJ open · 2016Pooled it
- The Effect of Early Goal-Directed Therapy on Outcome in Adult Severe Sepsis and Septic Shock Patients: A Meta-Analysis of Randomized Clinical Trials.Anesthesia and analgesia · 2016Pooled it
- Early goal-directed resuscitation for patients with severe sepsis and septic shock: a meta-analysis and trial sequential analysis.Scandinavian journal of trauma, resuscitation and emergency medicine · 2016Pooled it
- Pooled it
- A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators.Intensive care medicine · 2015Pooled it
- Early goal-directed therapy in the management of severe sepsis or septic shock in adults: a meta-analysis of randomized controlled trials.BMC medicine · 2015Pooled it
- The effect of fluid resuscitation on the effective circulating volume in patients undergoing liver surgery: a post-hoc analysis of a randomized controlled trial.Journal of clinical monitoring and computing · 2018Trial
- The Physiology, Pathophysiology, and Clinical Implications of Fluid Resuscitation in Critically Ill Patients.Cureus · 2026Review
- Beyond Fluid Therapy: The Role of Vitamin C, Steroids, and Thiamine in Sepsis Management.Cureus · 2025Review
- Efficacy of Early Goal-Directed Therapy in Septic Shock Management: A Systematic Review.Cureus · 2024Review
- Effect of systemic photobiomodulation in the course of acute lung injury in rats.Lasers in medical science · 2021Article
- Critical care echocardiography: diagnostic or prognostic?Annals of translational medicine · 2020Article
- Acute reversible hand ischemia after radial artery cannulation.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2020Article
- The Added Value of Lactate and Lactate Clearance in Prediction of In-Hospital Mortality in Critically Ill Patients With Sepsis.Critical care explorations · 2020Article
- Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management.Journal of clinical monitoring and computing · 2019Review
- Use of prehospital qSOFA in predicting in-hospital mortality in patients with suspected infection: A retrospective cohort study.PloS one · 2019Observational
- Quantitative capillary refill time predicts sepsis in patients with suspected infection in the emergency department: an observational study.Journal of intensive care · 2019Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe Surviving Sepsis Campaign guidelines recommend goal-directed therapy (GDT) for the early resuscitation of patients with sepsis. However, the findings of the ProCESS (Protocolized Care for Early Septic Shock) trial showed no benefit from GDT for reducing mortality rates in early septic shock. We performed a meta-analysis to integrate these findings with existing literature on this topic and evaluate the effect of GDT on mortality due to sepsis.
methodsWe searched the PubMed, Embase and CENTRAL (Cochrane Central Register of Controlled Trials) databases and reference lists of extracted articles. Randomized controlled trials comparing GDT with standard therapy or usual care in patients with sepsis were included. The prespecified primary outcome was overall mortality.
resultsIn total, 13 trials involving 2,525 adult patients were included. GDT significantly reduced overall mortality in the random-effects model (relative risk (RR), 0.83; 95% confidence interval (CI), 0.71 to 0.96; P =0.01; I 2 = 56%). Predefined subgroup analysis according to the timing of GDT for resuscitation suggested that a mortality benefit was seen only in the subgroup of early GDT within the first 6 hours (seven trials; RR, 0.77; 95% CI, 0.67 to 0.89; P =0.0004; I 2 = 40%), but not in the subgroup with late or unclear timing of GDT (six trials; RR, 0.92; 95% CI, 0.69 to 1.24; P =0.59; I 2 = 56%). GDT was significantly associated with the use of dobutamine (five trials; RR, 2.71; 95% CI, 1.20 to 6.10; P =0.02).
conclusionsThe results of the present meta-analysis suggest that GDT significantly reduces overall mortality in patients with sepsis, especially when initiated early. However, owing to the variable quality of the studies, strong and definitive recommendations cannot be made.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.