title: The effect of early goal-directed therapy for treatment of severe sepsis or septic shock: A systemic review and meta-analysis.
abstract: 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 control groups (relative risk [RR], 0.89; 95% confidence interval [CI], 0.79-1.00), with moderate heterogeneity (I2=56%). The EGDT was associated with lower mortality rates when the mortality rate of the usual care group was greater than 30% (12 trials; RR, 0.83; 95% CI, 0.72-0.96), but not when the mortality rate in the usual care group was less than 30% (5 trials; RR, 1.03; 95% CI, 0.92-1.16). The mortality benefit was seen only in subgroup of population analyzed between publication of the 2004 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.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Sun-Kyung
authors.initials: SK
authors.lastname: Park
authors.affiliation: Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors.forename: Su Rin
authors.initials: SR
authors.lastname: Shin
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Min
authors.initials: M
authors.lastname: Hur
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: wonhokim.ane@gmail.com.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Eun-Ah
authors.initials: EA
authors.lastname: Oh
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors.forename: Soo Hee
authors.initials: SH
authors.lastname: Lee
mesh_terms: D003422:Critical Care; D019091:Critical Pathways; D006801:Humans; D012151:Resuscitation / Q000379:methods; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy
keywords: Goal-directed therapy; Meta-analysis; Mortality; Sepsis