Comparison of Intermittent versus Continuous Superior Venal Caval Oxygen Saturation Monitoring in Early Goal Directed Therapy in Septic Shock: A Systematic Review

2021 ◽  
Author(s):  
Jhuma Mondal Sankar ◽  
Rashmi Ranjan Das ◽  
Udhaya Vijaya Kumar
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Continuous Monitoring ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Randomized Controlled ◽  
Significant Difference ◽  
All Cause Mortality

AbstractEarly goal directed therapy (EGDT) is a bundle of care (monitoring ScvO2 and lactate along with clinical parameters and instituting therapy) that has shown to improve outcomes in patients with septic shock. We conducted a systematic review of clinical trials and observational studies to compare intermittent versus continuous monitoring of ScvO2. We did major database searches till August 2020. Hospitalized children (>2 months age) and adults with septic shock were included. The intervention was “intermittent ScvO2 monitoring,” and the comparator was “continuous ScvO2 monitoring.” The primary outcome is “all-cause mortality.” Of 564 citations, 3 studies (n = 541) including both children and adults were included in the analysis. There was no significant difference in the “overall/all-cause mortality” (two randomized controlled trials; 258 participants) between the “intermittent” and “continuous” ScvO2 monitoring groups (relative risk [RR]: 1.00; 95% confidence interval [CI]: 0.8–1.24). However, a single observational study (283 participants) showed a significant increase in mortality in the intermittent group (RR: 1.46; 95% CI: 1.03–2.05). The GRADE evidence generated for “overall/all-cause mortality” was of “moderate certainty.” To conclude, the present meta-analysis did not find any significant difference between “intermittent” and “continuous” ScvO2 monitoring in patients with septic shock.

scholarly journals The Effectiveness and Safety of Acupuncture for Patients with Chronic Urticaria: A Systematic Review

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Qin Yao ◽  
Shanshan Li ◽  
Xiaoxu Liu ◽  
Zongshi Qin ◽  
Zhishun Liu
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Chronic Urticaria ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Symptom Improvement ◽  
Control Groups ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Significant Difference

Background. Acupuncture might have effectiveness in relieving the symptoms of chronic urticaria. There are currently no systematic reviews of acupuncture for chronic urticaria published in English.Objective. We conducted a systematic review to assess the effectiveness and safety of acupuncture for chronic urticaria.Methods. A systematic review and meta-analysis of randomized, controlled trials were performed. The primary outcome was global symptom improvement.Results. We included 6 studies with 406 participants. Three trials showed significant difference between acupuncture and drugs in global symptom improvement (relative risk 1.37; 95% CI 1.11–1.70;P=0.003). As an adjuvant to medication, acupuncture was also beneficial for global symptom improvement (relative risk 1.77; 95% CI 1.41–2.22;P<0.01). There were no severe adverse events related to acupuncture.Limitations. Some methodological limitations were observed. The overall risk of bias in the 6 included trials was high and all included RCTs were conducted in China and published in Chinese. Besides, the lack of proper control groups and the use of different rating methods and cut-offs in the included trials also made the evidence of this review limited.Conclusions. Acupuncture might be effective and safe for chronic urticaria in relieving symptoms, based on a low level of evidence. To draw a reliable conclusion, more high quality trials are needed in the future. This trial is registered with PROSPEROCRD42015015702.

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

2015 ◽  
Vol 41 (9) ◽  
pp. 1549-1560 ◽  
Author(s):  
D. C. Angus ◽  
A. E. Barnato ◽  
D. Bell ◽  
R. Bellomo ◽  
C.-R. Chong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Meta Analysis ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy

Early goal-directed therapy vs usual care in the treatment of severe sepsis and septic shock: a systematic review and meta-analysis

2015 ◽  
Vol 10 (6) ◽  
pp. 731-743 ◽  
Author(s):  
Anna Maria Rusconi ◽  
Ilaria Bossi ◽  
James Geoffrey Lampard ◽  
Michael Szava-Kovats ◽  
Andrea Bellone ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Usual Care ◽  
Meta Analysis ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Sepsis And Septic Shock

scholarly journals Antibiotic treatment duration for patients with bloodstream infection: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Yuting Li ◽  
Juan Yang ◽  
Hongmei Yang ◽  
Jianxing Guo ◽  
Dong Zhang
Keyword(s):  
Systematic Review ◽  
Antibiotic Treatment ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Source Control ◽  
Short Course ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Secondary Outcomes ◽  
Long Course

Abstract Objectives: The optimal duration of therapy for primary bloodstream infection (BSI) and BSI secondary to major organ system infections has been poorly defined. A systematic review and meta-analysis was performed to evaluate the impact of short (≤10 days)and long course(>10 days) of antibiotic treatment on clinical outcomes in patients with BSI.Methods: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials(RCTs) and cohort studies from inception to the 1st of October 2020. We included studies involving patients with BSI. All authors reported our primary outcome of all-cause mortality and clearly comparing short versus long course of antibiotic treatment with clinically relevant secondary outcomes(source control and relapse). Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI).Results: Six studies including 3593 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR=1.10; 95% CI, 0.82 to 1.48; P=0.52; Chi2=7.57; I2=34%) . Secondary outcomes demonstrated that there was no statistically significant difference in the source control(OR=0.82; 95% CI, 0.61 to 1.10; P=0.18; Chi2=2.68; I2=25%)and relapse(OR=1.20; 95%CI,0.71 to 2.01; P=0.49; Chi2=0.26; I2=0%) between two groups. Conclusions: Short course of antibiotic treatment is not associated with either an increased risk of mortality or an increased odds of relapse compared with longer antibiotic treatment course for BSI. Furthermore, short course of antibiotic therapy is non-inferior to long course in terms of source control. Further large-scale RCTs are still required to confirm these results.

scholarly journals Early goal-directed therapy versus usual care in the management of septic shock

CJEM ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 65-67
Author(s):  
Michael Gottlieb
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Intensive Care ◽  
Usual Care ◽  
Meta Analysis ◽  
Clinical Question ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy

Clinical questionDoes early goal-directed therapy decrease mortality when compared with usual care?Article chosenAngus DC, Barnato AE, Bell D, et al. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. Intensive Care Med 2015;41(9):1549-60. doi:10.1007/s00134-015-3822-1.

Mortality Benefit From the Passive Leg Raise Maneuver in Guiding Resuscitation of Septic Shock Patients: A Systematic Review and Meta-Analysis of Randomized Trials

2021 ◽  
pp. 088506662110197
Author(s):  
Moosa Azadian ◽  
Suyee Win ◽  
Amir Abdipour ◽  
Carolyn Krystal Kim ◽  
H. Bryant Nguyen
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Fluid Resuscitation ◽  
Standard Care ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Time Interval ◽  
Eligibility Criteria ◽  
Significant Difference ◽  
Passive Leg Raise

Background: Fluid therapy plays a major role in the management of critically ill patients. Yet assessment of intravascular volume in these patients is challenging. Different invasive and non-invasive methods have been used with variable results. The passive leg raise (PLR) maneuver has been recommended by international guidelines as a means to determine appropriate fluid resuscitation. We performed this systematic review and meta-analysis to determine if using this method of volume assessment has an impact on mortality outcome in patients with septic shock. Methods: This study is a systematic review and meta-analysis. We searched available data in the MEDLINE, CINAHL, EMBASE, and CENTRAL databases from inception until October 2020 for prospective, randomized, controlled trials that compared PLR-guided fluid resuscitation to standard care in adult patients with septic shock. Our primary outcome was mortality at the longest duration of follow-up. Results: We screened 1,425 article titles and abstracts. Of the 23 full-text articles reviewed, 5 studies with 462 patients met our eligibility criteria. Odds ratios (ORs) and associated 95% confidence intervals (CIs) for mortality at the longest reported time interval were calculated for each study. Using random effects modeling, the pooled OR (95% CI) for mortality with a PLR-guided resuscitation strategy was 0.82 (0.52 -1.30). The included studies were not blinded and they ranged from having low to high risk of bias using the Cochrane Risk of Bias Tool. Conclusion: Our analysis showed there was no statistically significant difference in mortality among septic shock patients treated with PLR-guided resuscitation vs. those with standard care.

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