Background
Methods
Data sources
Study selection and data extraction
Patients
Interventions
Standard EGDT
Comparison
Usual care
Outcomes
Study design
Randomized controlled trials (RCTs)
Quality assessment
Data analysis
Post hoc subgroup analysis
Results
Study/Year | Country | Setting | No. of patients | Resuscitation goals | Outcomea
| ||
---|---|---|---|---|---|---|---|
Intervention | Control | Intervention | Control | ||||
Rivers [7]/2001 | America | Eemergency department | 130 | 133 | SvO2 ≥ 70 % CVP 8–12 mmHg MAP 65–90 mmHg Urine volume ≥0.5 ml/kg/h | CVP 8–12 mmHg MAP 65–90 mmHg Urine volume ≥0.5 ml/kg/h | Hospital mortality |
Wang [45]/2006 | China | ICU | 16 | 17 | SvO2 ≥ 70 % CVP 8–12 mmHg MAP ≥65 mmHg Urine volume ≥0.5 ml/kg/h | MAP ≥65 mmHg Urine volume ≥0.5 ml/kg/h | 14 days mortality |
Yan [46]/2010 | China | ICU | 157 | 146 | ScvO2 ≥ 70 % CVP 8–12 mmHg SBP >90 mmHg MAP ≥65 mmHg Urine volume ≥0.5 ml/kg/h | CVP 8–12 mmHg SBP >90 mmHg MAP ≥65 mmHg Urine volume ≥0.5 ml/kg/h | ICU mortality |
ProCESS [6]/2014 | America | Eemergency department | 439 | 456 | ScvO2 ≥ 70 % CVP 8–12 mmHg MAP 65–90 mmHg Urine volume ≥0.5 ml/kg/h | Usual care | Hospital mortality |
ARISE [30]/2014 | Australia/New Zealand | Eemergency department | 793 | 798 | SpO2 ≥ 93 % ScvO2 ≥ 70 % CVP (Self-ventilation) >8 CVP (Non-invasive/invasive MV) >12 mmHg MAP 65–90 mmHg Urine volume ≥0.6 ml/kg/h Haematocrit ≥30 % | Usual care | 90 days mortality |
ProMISe [31]/2015 | UK | Eemergency department | 625 | 626 | ScvO2 ≥ 70 % CVP 8–12 mmHg MAP 65–90 mmHg Urine volume ≥0.5 ml/kg/h | Usual care | 90 days mortality |
Methodological quality
Primary outcome: mortality
Secondary endpoint-1: length of stay in the ED, ICU, and hospital
ED-LOS | ICU-LOS | Hospital-LOS | |||||||
---|---|---|---|---|---|---|---|---|---|
Author | EGDT | Usual care | P | EGDT | Usual care | P | EGDT | Usual care | P |
Yan [45] | 19.9 ± 2.2a
| 20.6 ± 1.9a
| 0.82 | NA | NA | NA | NA | NA | NA |
Rivers [7] | NA | NA | NA | NA | NA | NA | 13.2 ± 13.8a
| 13 ± 13.7a
| 0.54 |
ProCESS [6] | NA | NA | NA | 5.1 ± 6.3a
| 4.7 ± 5.8a
| 0.63 | 11.1 ± 10a
| 11.3 ± 10.9a
| 0.25 |
ARISE [30] | 1.4 (0.5–2.7)b
| 2.0 (1.0–3.8)b
| 0.001 | 2.8 (1.4–5.1)b
| 2.8 (1.5–5.7)b
| 0.81 | 8.2 (4.9–16.7)b
| 8.5 (4.9–16.5)b
| 0.89 |
ProMISe [31] | 1.5 (0.4–3.1) b
| 1.3 (0.4–2.9)b
| 0.34 | 2.6 (1.0–5.8)b
| 2.2 (0.0–5.3)b
| 0.005 | 9 (4–21)b
| 9 (4–18) b
| 0.46 |
Secondary endpoint-2: mechanical ventilation rate, renal replacement therapy rate and ICU admission
Mechanical ventilation | Renal replacement therapy | ICU admission | |||||||
---|---|---|---|---|---|---|---|---|---|
Author | EGDT | Usual care | P | EGDT | Usual care | P | EGDT | Usual care | P |
Rivers [7] | 65/130 | 84/133 | 0.02 | NA | NA | NA | NA | NA | NA |
ProCESS [6] | 165/434 | 146/451 | NA | 12/382 | 11/397 | NA | 401/439 | 393/456 | 0.01 |
ARISE [30] | 238/793 | 251/798 | 0.52 | 106/793 | 108/798 | 0.94 | 725/793 | 661/798 | NA |
ProMISe [31] | 179/620 | 175/615 | 0.9 | 88/620 | 81/614 | 0.62 | 551/625 | 467/626 | NA |
Secondary endpoint-3: intravenous fluids volume (ml), vasopressor use rate, dobutamine use rate and blood transfusion rate from 0 to 72 h
0–6 h | 6–72 h | 0–72 h | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Author | EGDT | Usual care | P | EGDT | Usual care | P | EGDT | Usual care |
P
| |
Wang [45] | Intravenous fluids (ml) | 4895 ± 210a
| 2340 ± 95a
| 0.01 | NA | NA | NA | NA | NA | NA |
Rivers [7] | Intravenous fluids (ml) | 4981 ± 2984a
| 3499 ± 2438a
| 0.001 | 8625 ± 5162a
| 10602 ± 6216a
| 0.01 | 13443 ± 6390a
| 13358 ± 7729a
| 0.73 |
Vasopressor use | 32/117 | 36/119 | 0.62 | 34/117 | 51/119 | 0.03 | 43/117 | 61/119 | 0.02 | |
Dobutamine use | 16/117 | 1/119 | 0.001 | 17/117 | 10/119 | 0.14 | 18/117 | 11/119 | 0.15 | |
Blood transfusion | 75/117 | 22/119 | 0.001 | 13/117 | 39/119 | 0.001 | 80/117 | 53/119 | 0.001 | |
ProCESS [6] | Intravenous fluids (ml) | 2805 ± 1957a
| 2279 ± 1881a
| 0.0001 | 4458 ± 3878a
| 4354 ± 3882a
| 0.08 | 7253 ± 4605a
| 6633 ± 4560a
| 0.0001 |
Vasopressor use | 241/439 | 201/456 | 0.003 | 209/439 | 197/456 | 0.38 | 265/439 | 245/456 | 0.05 | |
Dobutamine use | 35/439 | 4/456 | 0.0001 | 19/439 | 10/456 | 0.08 | 41/439 | 13/456 | 0.0001 | |
Blood transfusion | 63/439 | 34/456 | 0.001 | 87/439 | 82/456 | 0.54 | 120/439 | 102/456 | 0.22 | |
ARISE [30] | Intravenous fluids (ml) | 1964 ± 1415a
| 1713 ± 1401a
| 0.001 | 4274 ± 3071a
| 4382 ± 3136a
| 0.51 | NA | NA | NA |
Vasopressor use | 528/793 | 461/798 | 0.001 | 460/782 | 401/778 | 0.004 | NA | NA | NA | |
Dobutamine use | 122/793 | 21/798 | 0.001 | 74/782 | 39/788 | 0.001 | NA | NA | NA | |
Blood transfusion | 108/793 | 56/798 | 0.001 | 86/782 | 92/778 | 0.61 | NA | NA | NA | |
ProMISe [31] | Intravenous fluids (ml) | 2226 ± 1443a
| 2022 ± 1271 | NA | 4215 ± 3068a
| 4366 ± 3114 | NA | 5946 ± 3740a
| 5844 ± 3651a
| NA |
Vasopressor use | 332/623 | 291/625 | NA | 349/603 | 317/603 | NA | 377/623 | 344/625 | NA | |
Dobut mine use | 113/623 | 24/625 | NA | 107/603 | 39/603 | NA | 139/623 | 44/625 | NA | |
Blood transfusion | 55/623 | 24/625 | NA | 76/603 | 51/603 | NA | 107/623 | 65/625 | NA |