Evidence map›Paper›PMID 25952825›Full record

SynthesisIntensive care medicine2015

A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators.

D C Angus, A E Barnato, D Bell, R Bellomo, C-R Chong, T J Coats, A Davies, A Delaney, D A Harrison, A Holdgate and 13 more

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 180 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
180citing papers in PubMed, 6 pooled it
42.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

180 citing papers in PubMed, 6 syntheses or guidelines pooled it, 375 citations in OpenAlex.

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  9. Restrictive fluids versus standard care in adults with sepsis in the emergency department (REFACED): A multicenter, randomized feasibility trial.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2022
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120 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

23 authors at 16 institutions in 3 countries.

D C AngusDepartment of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA.
A E Barnato
D Bell
R Bellomo
C-R Chong
T J Coats
A Davies
A Delaney
D A Harrison
A Holdgate
B Howe
D T Huang
T Iwashyna
J A Kellum
S L Peake
F Pike
M C Reade
K M Rowan
M Singer
S A R Webb
L A Weissfeld
D M Yealy
J D Young
University of Pittsburgh · USMonash University · AUUniversity of Adelaide · AUAustin Hospital · AUBury College · GBChelsea and Westminster Hospital NHS Foundation Trust · GBIntensive Care National Audit & Research Centre · GBLiverpool Hospital · AULondon School of Hygiene & Tropical Medicine · GBNorthern Sydney Local Health District · AURoyal Perth Hospital · AUStatistics Collaborative · USUniversity of Leicester · GBUniversity of Oxford · GBUniversity of Queensland · AUVA Center for Clinical Management Research · US

Funding

Protocolized Care for Early Septic Shock (ProCESS)P50GM076659 · NIGMS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI ANGUS, DEREK C · 2006 to 2012
$11.2M
Department of Health 07/37/47NIGMS NIH HHS P50 GM076659
6 · The paper itself

Abstract

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.

Indexed as

Critical CareEarly Medical InterventionGoalsHumansRandomized Controlled Trials as TopicShock, Septic

Identifiers

PMID25952825
OpenAlexW300359691

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.