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

Alan E. Jones, Michael D. Brown, Stephen Trzeciak, Nathan I. Shapiro, John S. Garrett, Alan C. Heffner, Jeffrey Kline

Research output: Contribution to journalArticle

134 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2734-2739
Number of pages6
JournalCritical Care Medicine
Volume36
Issue number10
DOIs
StatePublished - Oct 2008
Externally publishedYes

Fingerprint

Resuscitation
Meta-Analysis
Sepsis
Mortality
Odds Ratio
Confidence Intervals
Chi-Square Distribution
Practice Guidelines
MEDLINE
Libraries
Publications
Hemodynamics

Keywords

  • Metaanalysis
  • Mortality
  • Resuscitation
  • Sepsis
  • Septic shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

The effect of a quantitative resuscitation strategy on mortality in patients with sepsis : A meta-analysis. / Jones, Alan E.; Brown, Michael D.; Trzeciak, Stephen; Shapiro, Nathan I.; Garrett, John S.; Heffner, Alan C.; Kline, Jeffrey.

In: Critical Care Medicine, Vol. 36, No. 10, 10.2008, p. 2734-2739.

Research output: Contribution to journalArticle

Jones, Alan E. ; Brown, Michael D. ; Trzeciak, Stephen ; Shapiro, Nathan I. ; Garrett, John S. ; Heffner, Alan C. ; Kline, Jeffrey. / The effect of a quantitative resuscitation strategy on mortality in patients with sepsis : A meta-analysis. In: Critical Care Medicine. 2008 ; Vol. 36, No. 10. pp. 2734-2739.
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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.",
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KW - Sepsis

KW - Septic shock

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