Evaluation of a modified early goal-directed therapy protocol

Crowe, Colleen; Mistry, C.; Rzechula, Kathleen H.; Kulstad, Christine

doi:10.1016/j.ajem.2009.03.007

Cited by 20 publications

(16 citation statements)

References 16 publications

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“…These teams have led to decreased mortality rates, 13 a decreased need for invasive monitoring in the ICU, 14 and an increased proportion of patients who receive goal-directed therapy per national guidelines. 15,16 The few published pediatric series have focused on the logistic difficulties with meeting Pediatric Advanced Life Support/American College of Critical Care Medicine (PALS/ACCCM) guidelines. These barri- ers primarily fall into 2 categories: delays in recognition and delays in implementation of resuscitative measures.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department

Cruz¹,

Perry²,

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Implementation of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department

Cruz¹,

Perry²,

et al. 2011

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“…[14] The study was approved by the hospital’s Institutional Review Board, with a waiver of informed consent.…”

Section: Methodsmentioning

confidence: 99%

Comparison of severity of illness scoring systems in the prediction of hospital mortality in severe sepsis and septic shock

Crowe

Kulstad

Mistry

et al. 2010

J Emerg Trauma Shock

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Background:New scoring systems, including the Rapid Emergency Medicine Score (REMS), the Mortality in Emergency Department Sepsis (MEDS) score, and the confusion, urea nitrogen, respiratory rate, blood pressure, 65 years and older (CURB-65) score, have been developed for emergency department (ED) use in various patient populations. Increasing use of early goal directed therapy (EGDT) for the emergent treatment of sepsis introduces a growing population of patients in which the accuracy of these scoring systems has not been widely examined.Objectives:To evaluate the ability of the REMS, MEDS score, and CURB-65 score to predict mortality in septic patients treated with modified EGDT.Materials and Methods:Secondary analysis of data from prospectively identified patients treated with modified EGDT in a large tertiary care suburban community hospital with over 85,000 ED visits annually and 700 inpatient beds, from May 2007 through May 2008. We included all patients with severe sepsis or septic shock, who were treated with our modified EGDT protocol. Our major outcome was in-hospital mortality. The performance of the scores was compared by area under the ROC curves (AUCs).Results:A total of 216 patients with severe sepsis or septic shock were treated with modified EGDT during the study period. Overall mortality was 32.9%. Calculated AUCs were 0.74 [95% confidence interval (CI): 0.67–0.81] for the MEDS score, 0.62 (95% CI: 0.54–0.69) for the REMS, and 0.59 (95% CI: 0.51–0.67) for the CURB-65 score.Conclusion:We found that all three ED-based systems for scoring severity of illness had low to moderate predictive capability. The MEDS score demonstrated the largest AUC of the studied scoring systems for the outcome of mortality, although the CIs on point estimates of the AUC of the REMS and CURB-65 scores all overlap.

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“…Shapiro (2006) (Shapiro et al, 2006) Talmor (2008) (Talmor et al, 2008). Puskarich (2009) (Puskarich, Marchick, Kline, Steuerwald, & Jones, 2009) study was excluded because same participants as Jones (2011) (Coba et al, 2011;Crowe et al, 2010;El Solh et al, 2008;Jones et al, 2007;Jones et al, 2011;Micek et al, 2006;Nguyen et al, 2007;Pro et al, 2014;Rivers et al, 2001;Talmor et al, 2008), 2 studies were performed in UK (Gao et al, 2005;Mouncey et al, 2015), 6 studies were performed in Asia (including 5 studies were performed in China(Q. H. Chen et al, 2008;Z. Q. Chen et al, 2007;Early Goal-Directed Therapy Collaborative Group of Zhejiang, 2010;He et al, 2007;Wang et al, 2006)[16-18, 22, 25] and written in Chinese, and one was performed in Asian countries (Na et al, 2012) including China), one study was performed in Australia (Investigators et al, 2014) ( Supplemental table 1).…”

Section: Trial Flowmentioning

confidence: 98%

“…After reviewing abstract and full text, 19 clinical trials were extracted to the meta-analysis, including 7 RCTs(Z. Q. Chen et al, 2007;Early Goal-Directed Therapy Collaborative Group of Zhejiang, 2010;Investigators et al, 2014;Mouncey et al, 2015;Pro et al, 2014;Rivers et al, 2001;Wang et al, 2006) and 12 prospective studies(Q. H. Chen et al, 2008;Coba et al, 2011;Crowe, Mistry, Rzechula, & Kulstad, 2010;El Solh, Akinnusi, Alsawalha, & Pineda, 2008;Gao, Melody, Daniels, Giles, & Fox, 2005;He, Gao, Wang, & Hang, 2007;Jones, Focht, Horton, & Kline, 2007;Jones, Troyer, & Kline, 2011;Micek et al, 2006;Na et al, 2012;Nguyen et al, 2007;Talmor et al, 2008) with 3502 EGDT participants and 3791 usual care participants(see figure 1 and figure 2). Shapiro (2006) (Shapiro et al, 2006) Talmor (2008) (Talmor et al, 2008).…”

Section: Trial Flowmentioning

confidence: 99%

Effect of early goal directed therapy in the treatment of severe sepsis and/or septic shock

Liu

Ding

Yang

2016

Current Medical Research and Opinion

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EGDT significantly reduced mortality in patients with severe sepsis and/or septic shock over 15 years since its publication. Recent studies examining usual care with EGDT have similar mortality benefit because of the diminished treatment effect. This treatment effect is diminished for multiple reasons. With progress in the management of this disease the benefit of EGDT on overall mortality has become comparable with the usual care for sepsis patients. This is because many of the components of EGDT have been incorporated into usual care protocols. As a result, the conclusion that EGDT is ineffective cannot be made. A more rigorous RCT which adjusts for the factors that narrows the treatment effect between groups is required. Given the current state of sepsis care and equipoise that exist, this would be difficult.

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Evaluation of a modified early goal-directed therapy protocol

Cited by 20 publications

References 16 publications

Implementation of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department

Implementation of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department

Comparison of severity of illness scoring systems in the prediction of hospital mortality in severe sepsis and septic shock

Effect of early goal directed therapy in the treatment of severe sepsis and/or septic shock

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