Effect of early goal directed therapy in the treatment of severe sepsis and/or septic shock: A meta-Analysis

Background: Many studies showed a dramatic mortality reduction after the use of early goal directed therapy (EGDT) in patients with severe sepsis and/or septic shock. Three large RCTs got neutral results for its usage compared with usual care group. So the debate whether EGDT could help in the management of severe sepsis and/or septic shock was a dilemma. Objectives: To determine the effect of EGDT in the treatment of severe sepsis and/or septic shock. Methods: A systematic review and meta-analysis of RCTs and prospective studies were performed, which extracted studies from Pubmed, Elsevier ScienceDirect, Cochrane, Clinicaltrials.gov, Google Scholar, China Knowledge Resource Integrated Database, and Wanfang Database. The mortality trend in the control group from included studies was analyzed. Results: Seven RCTs and twelve prospective studies were included, enrolling 3502 EGDT participants and 3791 usual care participants. EGDT could reduce overall mortality compared with usual care group. This reduction was resulted from the prospective studies and studies before 2010. There was a mortality reduction trend in the severe sepsis and/or septic shock patients received usual care. Limitations: This conclusion was limited by the small size of some selected studies, and the long time range of the studies selected. The bias in some included studies would also affect the overall result. Conclusions: EGDT helped in the mortality reduction in patients with severe sepsis and/or septic shock in the past years. With the progression in the management of this disease and mortality reduction in this disease, especially that some EGDT ingredients have been involved in usual care, the benefit of EGDT on overall mortality reduced to the comparable level as the usual care for sepsis patients. A more strict RCT is need to confirm the role of EGDT in the current clinical practice.